The Department of Health and Human Services (“HHS”) and the Department of Justice (“DOJ”) recently released the Health Care Fraud and Abuse Control Program Annual Report for 2019 (the “Report”). The Report provides an overview of the joint effort of the HHS and DOJ in identifying and prosecuting health care fraud in Fiscal Year 2019. The Report includes data regarding the number of civil and criminal cases opened by the Federal Government, the number of health care fraud-related convictions, judgments and settlements won by the Federal Government, and the dollar amount repaid to the Federal Government in 2019 for healthcare fraud-related judgments and settlements.
The DOJ initiated 1,112 new civil health care fraud-related investigations in 2019 and had more than 1,300 civil health care fraud-related matters pending at the end of the fiscal year. The DOJ also launched 1,060 new criminal health care fraud investigations in 2019, which led to 528 defendants being convicted of health care fraud-related crimes. While the overall number of new criminal health care fraud-related investigations slightly decreased from 2018 to 2019, the total number of new civil health care fraud-related investigations increased by more than 20% since 2018. By contrast, the Report shows a shift in the proportionality of OIG criminal investigations compared to civil investigations. In 2018 the OIG investigated 679 criminal actions and 795 civil actions. In 2019, the OIG investigated 747 criminal actions and 684 civil actions.
In total, the Federal Government won over $2.6 billion in health care fraud judgments and settlements in 2019. This figure marks a $300 million increase from 2018. The Federal Government recovered $3.6 billion in 2019, which includes amounts recovered from judgments and settlements from prior years. This figure marks a $1.3 billion increase from 2018. More than $250 million of the $3.6 billion recovered in 2019 was paid out to qui tam relators for claims under the False Claims Act (“FCA”). A qui tam relator is a private party that brings an FCA claim on behalf of the Federal Government.
The Report demonstrates that health care fraud-related investigations/lawsuits are on the rise. Further, there is clearly a tremendous financial incentive for both the Federal Government and qui tam relators to initiate health care fraud claims/investigations. Even when successfully defended, a health care fraud case can be extremely expensive for the provider. As such, providers/suppliers should be aware of applicable fraud and abuse laws and ensure that their practice’s operations adhere to such laws.
HLP attorneys have extensive experience in handling health care fraud litigation. The HLP also has extensive experience in compliance and regulatory guidance related to fraud and abuse. If you have any questions regarding the Health Care Fraud and Abuse Control Program Annual Report or fraud and abuse laws, please contact Clinton Mikel (firstname.lastname@example.org), or your regular HLP attorney, or call (248) 996-8510 or (212) 734-0128.