DOJ Reports Rise in FCA Recoveries Driven by Whistleblower Lawsuits

The DOJ's latest report reveals a slight rise in FCA recoveries to $2.9 billion, largely driven by whistleblower actions, with a focus on healthcare fraud and COVID-19-related cases.

The Department of Justice (DOJ) has announced a slight increase in financial recoveries for the 2024 fiscal year from cases brought under the False Claims Act (FCA), a crucial tool for combating fraud, waste, and abuse within government programs.

Overall recoveries for this year surpassed $2.9 billion, marking a 5% rise from last year and reaching a new three-year peak.

Notably, around $2.4 billion of these recoveries originated from qui tam lawsuits filed by whistleblowers.

The year 2023 saw a record-breaking 979 qui tam actions, underscoring the growing trend of private individuals stepping forward to report misconduct.

While healthcare fraud still dominates enforcement efforts, an increase in litigation has been observed across various industries, illustrating a broader commitment from both government and private sectors to pursue FCA investigations and prosecutions.

A Closer Look at FCA Recoveries

The substantial recovery of nearly $3 billion over the past year was achieved through a record total of 566 settlements and judgments.

However, this amount still falls significantly short of the record recovery years, like 2014, which saw totals of $6.2 billion, and 2021, with recoveries at $5.7 billion.

Key Enforcement Focus Areas

  • Combatting the Opioid Crisis: The DOJ remains vigilant in targeting healthcare entities implicated in the opioid epidemic.

    Investigations are particularly concentrated on organizations engaging in dubious marketing strategies and those prescribing or dispensing unnecessary opioids.

  • Medicare Advantage Program Oversight: Given that the Medicare Advantage Program accounts for the largest share of Medicare expenses and caters to millions of beneficiaries, the DOJ considers this sector essential for FCA enforcement initiatives.
  • COVID-19 Fraud Investigations: With substantial funds disbursed during the COVID-19 pandemic, the DOJ is scrutinizing improper payments linked to the Paycheck Protection Program, alongside fraudulent claims regarding testing and treatment.

    Alarmingly, nearly half of this year’s total settlements were tied to pandemic-related fraud.

  • Scrutiny of Anti-Kickback Statute and Stark Law Violations: Allegations surrounding breaches of the Anti-Kickback Statute (AKS) and Stark Law remain a significant focus in FCA litigation, especially among healthcare providers.

    Recently, there has been a notable uptick in enforcement actions related to Stark Law violations.

  • Claims of Medically Unnecessary Services: Accusations of delivering medically unnecessary services continue to form a substantial basis for FCA liability claims.

    Yet, this area poses challenges, given the often subjective nature of clinical decision-making.

Overall, the 2024 recovery figures reflect both the diligent efforts of the DOJ and the increasing willingness of whistleblowers to shine a light on fraudulent activities, paving the way for justice in various sectors.

Source: Natlawreview.com