(Legal Newsline) – A federal program that was implemented in 1997 and designed
to target health care fraud took off under President Obama.
its most recently filed annual report, the Health Care Fraud and Abuse Control Program
has taken in more than $16.2 billion since fiscal year 2009, with the results
of fiscal year 2016 still to be added.
previous 12 years, the program recovered approximately $13 billion. The report
also showed that for every dollar spent on health care fraud-related
investigations, the government recovered $6.10.
programs that turn a profit for public funds are rare, and they tend to receive
ongoing funding and support,” DLA Piper’s Karen Nelson recently wrote. She is a
former deputy inspector general and chief counsel for the Texas Health and Human
Services Commission’s Office of Inspector General.
reasonable to expect that the HCFAC agencies will continue to receive modest
annual budget increases for the foreseeable future and that existing
enforcement programs will perpetuate."
year 2015, Department of Justice opened 983 new criminal health care fraud
investigations and filed charges in 463 cases against 888 defendants. In the
same fiscal year, 613 defendants were convicted of health care fraud-related
program’s continued success confirms the soundness of a collaborative approach
to identify and prosecute the most egregious instances of health care fraud, to
prevent future fraud and abuse, and to protect program beneficiaries,” the
initiative, undertaken by the DOJ and the Department of Health and Human
Services, experienced a landmark in June 2016 with the announcement of charges
against 301 individuals for the false billing of approximately $900 million.
It’s a solid
bet that the trend of recovery will continue when 2016 statistics are released.
The DOJ has announced it recovered $4.76 billion in False Claims Act cases in
fiscal year 2016 – an increase of 25 percent over the previous year.
The FCA is
used by the government and private whistleblowers to, in part, target health
care providers who overbill Medicare and Medicaid for products and services.
companies and local doctors have been targeted by the program. The actions of Strike
Force teams in nine areas have resulted in 2,185 indictments and nearly $2
billion in recoveries.
One of the
highest-profile actions in 2016 involved Wyeth Inc. and its owner Pfizer. The
two reached a $784.6 million settlement to resolve allegations Wyeth reported
false pricing information and underpaid rebates due under a Medicaid program.
Wyeth failed to report discounts it offered to hospitals for bundled sales of
the drug Protonix, it was alleged, leading to false pricing information to CMS
and underpaid rebates to states.
press release said it was glad to put the matter behind it, but one target of a fraud investigation is
fighting against certain measures taken by CMS.
year, Arriva, a subsidiary of Alere, disclosed that it submitted Medicare
claims on behalf of 211 deceased patients over a five-year period. CMS
responded by revoking the company’s Medicare enrollment.
It’s part of
a recent string of events that has jeopardized Alere’s merger with Abbott
Laboratories. Arriva has filed an appeal with a CMS administrative law judge in
an effort to have its Medicare enrollment reinstated.
The company also
has asked the Washington, D.C., federal court, to put a stay on the revocation
while the appeal of it is pending.
December complaint, the company claims it was targeted by CMS in an effort to
reduce a backlog at the agency.
decision by CMS to bar Arriva from participating in Medicare is driven by a
desire to reduce its longstanding backlog of administrative claim-reimbursement
appeals,” Alere says.
that the court recently ordered CMS to clear that backlog by 2020, and… CMS
perceives Arriva to be a contributor to that backlog because Arriva has been
forced to appeal approximately 25,000 errantly denied claims over the past five
expects the CMS administrative law judge to issue a decision in the next few
to the lawsuit, the DHHS has asked the court to dismiss Arriva’s complaint.
administrative appeal of the revocation is proceeding apace, so any claim of
urgency related to the revocation is undermined considerably,” the DHHS wrote.
the applicable law provides that if Plaintiff is successful in getting a
Medicare revocation overturned, Plaintiff will receive a complete restoration of
asking a Delaware court to nix its proposed merger with Alere, citing a recall
of INRatio monitoring systems and the government’s investigation.
have sued Alere and named executives at the company for the subsequent stock
well knows, none of the issues it has raised provides it with any grounds to
avoid closing the merger,” a statement from Alere said.