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.
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.