George B. Breen, Member of the Firm in the Health Care & Life Sciences and Litigation practices and Co-Chair of the firm’s National Health Care & Life Sciences Practice Steering Committee, in the firm’s Washington, DC, office, was quoted in Fierce Healthcare, in “DOJ Secured $1.7B from Healthcare False Claims Settlements, Judgments in 2024,” by Dave Muoio.

Following is an excerpt:

The Department of Justice (DOJ) recouped more than $2.9 billion for the federal government from False Claims Act settlements and judgements during the 2024 fiscal year, with nearly $1.7 billion of the total related to healthcare.

Those tallies, announced Wednesday, included the highest-ever number of whistleblower cases in a single year—979 filings that contributed to $2.4 billion of the total and put more than $400 million into the whistleblowers’ pockets. 

The top-line number outpaces fiscal 2023’s $2.7 billion, though the healthcare tally is slightly below that year’s over $1.8 billion related to healthcare. Fiscal 2021 remains the most lucrative year for False Claims settlements and judgements, with more than $5 billion.

“The False Claims Act and its whistleblower provisions remain a critical tool in protecting the public fisc and ensuring that taxpayer funds serve the purposes for which they were intended,” Principal Deputy Associate Attorney General Benjamin Mizer said in a statement.

False Claims Act recoveries help restore funds to federal healthcare programs including Medicare, Medicaid and TRICARE, the DOJ said. The $1.7 billion of healthcare recoveries only relates to federal losses, “but in many of these cases, the Department was instrumental in recovering additional amounts for state Medicaid programs,” it said.

The department’s announcement put a spotlight on settlements and recoveries related to companies and individuals who it said contributed to the country’s opioid epidemic, delivered unnecessary services and substandard care, took advantage of the Medicare Advantage program, paid out unlawful kickbacks for services and committed other types of healthcare fraud.

More than two dozen such examples were highlighted in the release.

Rite Aid Corporation and several of its affiliates, for instance, paid $7.5 million and agreed to provide an allowed, unsubordinated, general unsecured claim of $401.8 million in its bankruptcy case to resolve allegations it knowingly improperly dispensed prescriptions for controlled substances. Drug manufacturer Endo Health Solutions, which is currently in bankruptcy, also agreed to a $475.6 million claim over allegations that it aggressively marketed an opioid to high-volume prescribers.

Beyond opioids, Rite Aid and its subsidiaries were named a second time in the release for a $121 million settlement tied to inaccurately reporting drug rebates to Medicare.

Several healthcare providers were listed among the highlighted cases as well. Among the larger recoveries were $345 million from Community Health Network in a settlement related to services referred in violation of the Stark Law.

CVS Health’s primary care affiliate Oak Street Health paid the government $60 million to resolve allegations of kickback payments to third-party insurance agents in exchange for recruiting seniors to its clinics. Dialysis care company DaVita agreed to a $34.5 million payment over allegations of kickbacks to a competitor to induce referrals, while behavioral health care provider Acadia Healthcare Company paid $16.6 million over alleged billing for unnecessary services, improper discharges and staffing shortcomings.

The DOJ also noted a $106.8 million settlement with Walgreens related to allegations of billing government programs for prescriptions that were processed and never picked up.

“The Department places a high priority on fighting fraud and abuse in federal programs,” Principal Deputy Assistant Attorney General Brian Boynton, head of the DOJ’s Civil Division, said in a statement. “The results announced today highlight once again that such conduct will not be tolerated, and that those who knowingly misuse taxpayer funds will be held accountable.”

The totals for fiscal year 2024, which ended Sept. 30, 2024, did not include the “significant” $450 million settlement with generic drug maker Teva Pharmaceuticals, the DOJ noted.

On the year’s Medicare Advantage investigations, the department added that it has continued to litigate “a number of other cases involving the Medicare Advantage program, including actions against UnitedHealth Group, Elevance Health (formerly Anthem), and the Kaiser Permanente consortium.”

In an emailed statement on the statistics, George Breen, chair of Epstein Becker Green’s national healthcare and life sciences practice, noted that "while more healthcare cases were filed by relators in 2024 than in 2023, the number of cases brought by the U.S. government, on its own, dropped by more than 10% over 2023. Indeed, total healthcare fraud recoveries, recoveries in cases pursued by the government, in cases in which the government intervened, and in cases where relators pursued matters on their own all were lower last year."

Breen added that the total healthcare recovery is still "staggering" and doesn't suggest that the DOJ has pulled back on pursing these cases. 

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