The U.S. Justice Department is reporting it recovered the lowest amount of money from healthcare fraud cases in any year since 2009, according to new government data.
The decline is largely due to the absence of major drug industry settlements, and doesn't reflect an easing of DOJ scrutiny of healthcare fraud, experts say.
“The recoveries are still high, and there's still a real focus at the Department of Justice on these cases,” said Jennifer Weaver, a partner at Waller Lansden Dortch & Davis who represents providers, after noting she's not seeing any decrease in healthcare fraud cases and that many are still under seal, or confidential.
The DOJ pulled in more than $1.9 billion from healthcare fraud settlements and judgments in 2015, according to the department. That's down from $2.4 billion in 2014, and a record-setting $3 billion in 2012. The $1.9 billion recovered this year makes up more than half of the $3.5 billion the government recouped from fraud cases across all industries.
Whistle-blowers earned $330 million from healthcare fraud cases this year. In successful False Claims Act cases, whistle-blowers are entitled to a percentage of what the government recovers.
Two of the largest healthcare recoveries this year were from dialysis provider DaVita Healthcare Partners. DaVita agreed in May to pay $450 million to settle allegations that it overbilled Medicare and Medicaid for drugs it wasn't fully using. DaVita Chief Legal Officer Kim Rivera said at the time that settlement was in its stakeholders' best interest.
DaVita then agreed in October to pay $350 million to settle allegations that it paid kickbacks to doctors for referrals to its dialysis clinics. DaVita said at the time “there was no intentional wrongdoing.”
Hospitals also paid nearly $330 million in settlements and judgments in 2015, according to the department. That includes $216 million recovered this past fiscal year from more than 450 hospitals that settled with the government as part of a years-long investigation related to the suspected overuse of implantable cardiac defibrillators.