The U.S. Department of Justice (DoJ) announced that it obtained more than $2.68 billion in settlement and judgements under the False Claims Act. The government and whistleblowers were party to 543 settlements and judgments, the highest number of settlements and judgments in a single year. Recoveries since 1986, when Congress substantially strengthened the civil False Claims Act, now total more than $75 billion.
“Protecting taxpayer dollars from fraud and abuse is of paramount importance to the Department of Justice – and these enforcement figures prove it,” said Acting Associate Attorney General Benjamin Mizer. “The False Claims Act remains one of our most important tools for rooting out fraud, ensuring that public funds are spent properly, and safeguarding critical government programs.”
The False Claims Act penalizes those who knowingly and falsely claim money from the United States or knowingly fail to pay money owed to the United States. Its purpose is to safeguard government programs and operations that provide access to medical care, support our military and first responders, protect American businesses and workers, help build and repair infrastructure, offer disaster and other emergency relief, and provide many other critical services and benefits.
“As the record-breaking number of recoveries reflects, those who seek to defraud the government will pay a high price,” said Assistant Attorney General Boynton, head of the DoJ’s Civil Division. “The American taxpayers deserve to know that their hard-earned dollars will be used to support the important government programs and operations for which they were intended.”
Of the more than $2.68 billion in False Claims Act settlements and judgments reported by the DoJ this past fiscal year, over $1.8 billion related to matters that involved the health care industry, including managed care providers, hospitals, pharmacies, laboratories, long-term acute care facilities, and physicians. The $1.8 billion only include recoveries arising from federal losses, but in many of these cases, the department was instrumental in recovering additional amounts for state Medicaid programs.
Health Care Fraud
In 2023, health care fraud remained a leading source of False Claims Act settlements and judgments. These recoveries restore funds to federal programs such as Medicare, Medicaid, and TRICARE, the health care program for service members and their families. But just as important, enforcement of the False Claims Act deters others who might try to cheat the system for their own gain, and in many cases, also protects patients from medically unnecessary or potentially harmful actions. As in years past, the act was used to pursue matters involving a wide array of health care providers, goods, and services.
In one of its largest settlements, The Cigna Group agreed to pay more than $172 million for allegations that it submitted inaccurate diagnosis codes for its Medicare Advantage Plan enrollees in order to increase its payments from Medicare. The DoJ obtained another $22.5 million from Martin’s Point Health Care for similar allegations.
The Department also received numerous settlements and judgements from companies who engaged in unnecessary services and substantial care, the opioid epidemic, and unlawful kickbacks.
Although these actions exhibit the DoJ’s focus on the healthcare industry, the recoveries in 2023 also reflect the department’s focus on key enforcement priorities, including fraud in pandemic relief programs and alleged violations of cybersecurity requirements in government contracts and grants. However, considering the trends of the past year, it is reasonable to anticipate that healthcare will continue to be a primary focus for the Department. 