Fighting health care fraud paid off to the tune of $2.3 billion for the feds over the last year.
$5.69 Billion Jackpot
The U.S. Department of Justice (DOJ) said on November 20, 2014 that for its previous fiscal year it recovered that amount in cases involving false claims against federal health care programs like Medicare, Medicaid and TRICARE. Accounting for all fraud cases, the department brought in a whopping $5.69 billion.
Record Recoveries
Acting Associate Attorney General Stuart Delery said, “In the past three years, we have achieved the three largest annual recoveries ever recorded under the statute. This sustained success demonstrates that these figures result not only from large individual matters, but from a continuous commitment year after year to pursue those who defraud taxpayers and to remain vigilant in identifying those who would unlawfully obtain money from the federal fisc.”
While the $2.3 billion for health care fraud was big and marks the fifth straight year of over $2 billion in recoveries, health care crooks were pikers compared to the really big boys on Wall Street who got socked for $3.1 billion for false claims for federally insured mortgages and loans.
The total amount reported by the feds only reflected federal losses and in many cases additional dollars went back to consumers and state treasuries.
J&J’s Big Pocketbook
Orthopedic settlements didn’t even merit mention, as Johnson & Johnson’s (J&J) pharmaceutical business accounted for a substantial part of the $2.3 billion in recoveries. J&J and its subsidiaries, Janssen Pharmaceuticals and Scios, paid $1.1 billion to resolve False Claims Act claims relating to the prescription drugs Risperdal, Invega and Natrecor. The government also accused J&J of paying kickbacks to physicians and to Omnicare Inc., the nation’s largest provider of pharmaceuticals to nursing homes and long-term care facilities. In addition to the federal civil settlement, the DOJ says J&J paid more than $600 million in civil claims for state Medicaid programs and $485 million in criminal fines and forfeitures, making it one of the largest health care fraud settlements in U.S. history. The government also recovered $116 million from Omnicare.
Hospital Misbehavior
Cases involving hospitals only got hit for $333 million in settlements and judgments, with significant recoveries from two hospital chains. Community Health Systems Inc., the nation’s largest operator of acute care hospitals, paid $98.15 million to settle allegations that it billed Medicare, Medicaid and TRICARE for inpatient services that should have been provided in an outpatient or observation setting. Halifax Hospital Medical Center and Halifax Staffing Inc., hospital service providers in Florida, paid $85 million to resolve allegations that it violated the Stark Law, which prohibits hospitals from billing Medicare for certain services when referred by physicians who have a financial relationship with the hospital.
Amedisys, Inc., a large home health services provider got nicked for $150 million to resolve allegations that it billed Medicare for medically unnecessary services, for services to patients who were not homebound and for violations of the Anti-Kickback Statute.
Cardio
Cardio had three big cases where the government recovered $85 million based on claims involving potentially life threatening conduct.
Boston Scientific Corp., which purchased Guidant LLC and Guidant Sales LLC, and Cardiac Pacemakers Inc. in 2006, paid $30 million to settle claims that Guidant sold defective heart devices to hospitals that implanted them into Medicare patients. The Guidant devices allegedly short circuited, rendering them ineffective.
In the other two cases, Kentucky hospitals King’s Daughters Medical Center and Saint Joseph Health System Inc. billed Medicare and Medicaid for coronary procedures the government alleged were unnecessary. King’s Daughters paid $39 million in federal claims and $2 million in state Medicaid claims to settle allegations that it billed for medically unnecessary coronary stents and diagnostic catheterizations, and that it had prohibited financial relationships with physicians referring patients to the hospital. St. Joseph’s paid $16 million in federal claims and $366, 000 in state Medicaid claims to settle allegations that St. Joseph Hospital in London, Kentucky, billed Medicare and Medicaid for numerous invasive cardiac procedures that were performed on patients who did not need them, including procedures involving coronary stents, pacemakers, coronary artery bypass graft surgeries and diagnostic catheterizations.
It’s interesting to note that all the mentioned cases were settled without anyone admitting guilt and getting the Medicare death penalty.
