What Health Care FCA Trends Tell Us About the Year Ahead

Law360

George B. Breen, David E. Matyas, Erica Sibley Bahnsen, and Alexis Boaz, co-authored an article in Law360, titled “What Health Care FCA Trends Tell Us About the Year Ahead.” (Read the full version – subscription required.)

Following is an excerpt:

Following a small drop in 2018, total recoveries under the False Claims Act in fiscal year 2019 again exceeded $3 billion. Significantly, health care-related fraud recoveries alone have surpassed $2 billion for 10 consecutive years. The U.S. Department of Justice credits this year’s increased recoveries in part to large settlements with pharmaceutical manufacturers, particularly within the opioid industry.

Although the overall number of qui tam cases filed fell slightly in fiscal year 2019, the government increasingly initiated matters, as demonstrated by the fact that recoveries from health care-related cases brought directly by DOJ increased from $568 million to $695 million between FY 2018 and FY 2019, the second highest amount recovered from such cases in 30 years.

This article explores important and recent DOJ policy changes and trends, examines sectors of the health care industry facing higher scrutiny in 2019, and suggests areas to watch in 2020.