The Department of Justice (DOJ) recovered $3.7 billion in False Claims Act (FCA) lawsuits in 2017, alone, continuing a strong trend over recent years and decades to support private citizens in pursuing fraud perpetrated against the federal government. Of this amount, over $900 million in recoveries were due to actions pursued against healthcare providers and drug makers. This is not surprising, given the massive amounts of fraud engaged in by health care industry participants in connection with the federal Medicare and Medicaid programs.
In fact, that number is only a small fraction of the actual amount of Medicare and Medicaid fraud, with some estimates indicating $100 billion in such fraud occurs each year. This means the DOJ, despite all its work, has recovered less than 1% of the total amount of fraud in 2017. Because FCA claims are generally pursued initially by private citizens who become aware of facts related to fraud, the burden is often on employees, executives, and even patients and their families to notice healthcare fraud occurring and bring it to the government’s attention with the assistance of a whistleblower attorney.
Those who do so can be richly rewarded for their efforts, as FCA whistleblowers are eligible to receive between 15% and 25% of the federal government’s total recoveries. Looking at the very large nine-figure settlements below, it is easy to see why pursuing a healthcare whistleblower FCA claim can be well worth it.
Shire Pharmaceuticals Pays $350 Million to Settle FCA Claims
The pharmaceutical company paid $350 million in a settlement over various allegations of health care fraud related to Advanced BioHealing (ABH), a company that was acquired by Shire in 2011. According to the DOJ, the company had illegally induced doctors to unnecessarily prescribe its skin substitute by “offering lavish dinners, drinks, entertainment and travel; medical equipment and supplies; unwarranted payments for purported speaking engagements and bogus case studies; and cash, credits and rebates.”
In addition to these illegal kickbacks, the company also “made false statements to inflate the price of the product, and caused improper coding, verification, or certification of claims for the product and related services.”
Mylan Inc. Pays $465 Million Related to Healthcare Fraud
Mylan, Inc., manufacturer of the EpiPen, paid the largest amount of healthcare fraud claims – nearly half a billion dollars – in connection with misclassifying the EpiPen as a generic medical product in order to avoid giving higher rebates for Medicare or Medicaid claims. The EpiPen, which is a brand-name product with no generic equivalents, was thus used to defraud the federal and state governments out of Medicare and Medicaid funds at the same time the company raised the cost for the EpiPen by 400%.
Life Care Centers Pays $165 Million over Assisted Living Fraud
Assisted living facilities are more and more ground zero for unscrupulous health care providers who attempt to defraud state and federal governments via false or inflated Medicare and Medicaid reimbursements.
Life Care Centers paid $165 million to settle claims this year related to a variety of fraudulent practices at its assisted living facilities, including submitting false claims for rehabilitation therapy that was not necessary; keeping patients longer than needed to increase billings; and “corporate-wide policies and practices designed to place beneficiaries in the highest level of Medicare reimbursement…irrespective of the clinical needs of the patients, resulting in the provision of unreasonable and unnecessary therapy to many beneficiaries.”
eClinicalWorks Pays $155 Million Over False Claims
Finally, eClinicalWorks, a national health records software vendor, was fined $155 million over corporate practices intended to conceal the fact that its software did not comply with federal certification standards. These issues with the software allowed physicians to use the software to obtain inflated reimbursements for coverage that was not properly certified. The company also engaged in a kickback scheme to get doctors to use the software.
Bring Your Healthcare Fraud Case with Experienced Whistleblowing Attorneys You Can Trust
Our nation and its taxpayers relies on courageous insiders like you to come forward with information that can stop harmful Medicare fraud. At Kreindler & Associates, our experienced healthcare fraud attorneys will work with you every step of the way to determine your appropriate course of action, protect you from retaliation, and collect your much-deserved reward. If you suspect that someone is committing Medicare or Medicaid fraud, contact us today for an evaluation of your allegations.
