Department of Justice and HHS-OIG Recover $2.4 Billion in FY 2015

Posted on Health Care Law News by Robert Nicholson

The government has released its annual HCFAC Report for fiscal year 2015.  In the report, the government touts its recovery of $2.4 billion through civil and criminal enforcement efforts.  Of that amount, approximately $1.6 billion was returned to the Medicare Trust Funds, approximately $386 million was paid to federal agencies for restitution/compensatory damages, and approximately $414.5 million was paid to relators in False Claims Act cases.

The Report also notes that DOJ and HHS received $380 million more in funding in 2015 than they did in 2014, and boasted of a return of $6.10 per every dollar spent.

In 2015, DOJ initiated 983 new criminal investigations, and over 800 new civil investigations.

The Report, as it does annually, lists a number of case successes, some of which are summarized below:

  • A Chief Financial Officer of a regional medical center was sentenced to approximately two years in jail and payment of $4.4 million in restitution after pleading guilty to certifying to CMS that the medical center met meaningful use requirements after being fully aware that it did not meet the criteria for incentives.
  • A physician agreed to pay $425,000 and a regional medical center agreed to pay more than $25 million to settle civil False Claims Act (FCA) allegations that they submitted claims to federal health care programs that violated the Stark Law. The government alleged that the system provided excessive salary and directorship payments to the physician and submitted claims for services at higher levels than supported by documentation.
  • An $11.5 million settlement was reached with five ambulance companies to settle civil FCA allegations that they engaged in “swapping” kickback schemes by providing deeply discounted and below-cost ambulance services to hospitals and/or skilled nursing facilities in exchange for exclusive rights to more lucrative Medicare referrals.
  • An operator of a sham clinic was convicted and sentenced to 15 years in federal prison for fraudulently prescribing anti-psychotic medications, selling drugs on the black market, and then redistributing them to pharmacies. This was the first case in the nation involving an organized scheme to defraud government health care programs through fraudulent claims for anti-psychotic medications.
  • A physician-owned dermatology practice agreed to pay $3.2 million to settle civil FCA allegations that its financial relationships with employed physicians violated the Stark Law. The practice routinely required its physicians to use its in-house pathology lab for pathology services, and billed Medicare for analyses performed by the lab on specimens sent by these physicians.
  • The first investigation under the Food and Drug Administration Pharmaceutical Fraud Program concluded in 2015 with a net $25 million recovery. This investigation, which began in 2010, resulted in a large, Philadelphia-based prescription and over-the-counter drug manufacturer pleading guilty to “introducing adulterated infant’s and children’s liquid medications into interstate commerce.”