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Information About the Major 2021 Medicare Part C Fraud Settlements

Healthcare fraud costs the United States billions of dollars every year—and those are just the schemes that get uncovered.

This was true once again in 2021, as healthcare fraud was the top source of False Claims Act violations for the year. Of $5.6 billion in total False Claims Act settlements and judgements last year, approximately $5 billion worth was related to Medicare and Medicaid fraud. In addition, of that $5.6 billion total, more than $1.6 billion started under qui tam provisions of the False Claims Act, which allow whistleblowers to file claims on behalf of the federal government.

Throughout the year, the government paid out approximately $237 million to whistleblowers to exposed instances of healthcare fraud and false claims.

Spotlight on Medicare Part C fraud

The most frequently pursued cases by the DOJ included cases against prescription opioid manufacturers, unlawful kickbacks, unnecessary medical services and Medicare Advantage Plans (Medicare Part C).

Medicare Part C fraud is considered to have especially harmful effects on Medicare beneficiary care, the trustworthiness of medical professionals, taxpayer investments and the reputation of the Medicare Advantage Plan.

There were a number of high-profile Medicare Part C settlements with the DOJ in 2021. One, for example, came with Sutter Health in California to the tune of $90 million. In this case, the organization was alleged to have knowingly added unsupported diagnosis codes to medical records of Medicare patients, which resulted in improper payments and false claims.

These types of schemes are quite common within the broader range of healthcare fraud, and limiting their occurrence has been a top priority of the DOJ and securities agencies.

For more information about the steps you can take if you become aware of healthcare fraud within your organization, contact an experienced whistleblower attorney at Kardell Law Group.

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  • "Incredible knowledge of employee related concerns and equally brilliant knowledge of health care regulations, standards of practice. I would recommend this firm to anyone."  -V.B.

  • "Reaching out to Steve Kardell was the best decision I made. His ability to provide immediate insight and direction was very powerful, and a huge relief during a very stressful time period. For anyone struggling with a whistleblower situation, I would highly recommend at least speaking with Steve. After a 10 minute call with him, I had a better understanding of what I was dealing with. Even better, he gave me some immediate hope. In the end Steve did a better job than I thought was possible. Steve was able to get in contact with people in my organization, that I didn’t have access to. Because of his years of experience, he already has contacts in many organizations in Dallas. The entire situation was handled peacefully. I was impressed by his ability to “keep the peace”–rather than creating a battle with the organization. The reason I didn’t reach out to a lawyer initially, was because I thought it would mean an immediate end to any hope of a positive relationship with the company. Steve was able to address my concerns, and in the end I was able to continue to work for them."  -KS

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