Bob Miller  |  August 5, 2022

Category: Legal News

Top Class Actions’s website and social media posts use affiliate links. If you make a purchase using such links, we may receive a commission, but it will not result in any additional charges to you. Please review our Affiliate Link Disclosure for more information.

$10 million whistleblower award recently awarded

Fraud cases in the healthcare industry are on the rise. The U.S. Department of Justice oversaw more than $5.6 billion in settlements involving false claims in the Fiscal Year 2021. Of that amount, $5 billion is related to fraud and abuse within the healthcare industry. It’s the second largest amount in the history of the False Claims Act and the largest since 2014.

The False Claims Act deals with cases that defraud taxpayers by scamming government programs. According to the DOJ, many cases involved drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories and physicians. Many of these cases were made possible by whistleblowers in what are known as qui tam actions. Qui tam actions incentivize and protect whistleblowers for helping the government discover and prosecute fraudulent activities.

Opioid fraud

The DOJ has been using the False Claims Act to take on companies that pushed highly addictive Opioids. The department reported that Indivior Inc., Indivior PLC and Purdue Pharma were hit as part of a $600 million resolution relating to the Opioid epidemic. 

Indivior paid $209.3 million to the federal government to settle allegations that it promoted its drug Suboxone to doctors who were writing prescriptions that were not for medical purposes. According to the DOJ, the company “made false and misleading claims” that its drug was less susceptible to abuse and to accidental exposure to children than other products. The company Indivior Solutions pleaded guilty to a criminal felony charge of making false statements relating to healthcare matters. Purdue agreed to a $2.8 billion settlement to resolve allegations that it promoted its opioid drugs to doctors it knew were unsafe, ineffective, medically unnecessary, and led to abuse and diversion. 

Purdue Pharma pled guilty in federal court to a three-count felony, with one count of dual-object conspiracy to defraud the United States and to violate the Food, Drug, and Cosmetic Act, and two counts of conspiracy to violate the Federal Anti-Kickback Statute. Purdue was accused of paying kickbacks to doctors and specialty pharmacies to increase prescriptions of its addictive drugs. Certain shareholders and board members at Purdue paid $225 million to resolve False Claims Act allegations that they intensified the marketing of OxyContin to extreme, high-volume prescribers, which fueled the Opioid addiction crisis.

Medicare fraud

Many False Claim Act settlements involve kickbacks or scams of Medicare. Often these cases involve a qui tam action. When the government prevails in a qui tam action, the whistleblower typically receives a portion of the recovery, ranging from 15% to 30%. The DOJ reports that whistleblowers filed 598 qui tam suits in 2021, with settlements and judgments exceeding $1.6 billion. This provides an incentive for employees to come forward and report their employers for fraud against the government.

Some of the more notable False Claims Act cases involving Medicare included Sutter Health, which paid $90 million following allegations it submitted fake diagnosis codes, resulting in inflated payments to be made to the Medicare Advantage Plans and Sutter Health. The Kaiser Foundation Health Plan of Washington paid $6.3 million for similar allegations.

Kickback fraud

A company called Arriva Medical LLC agreed to pay $160 million after it was accused of taking kickbacks in relation to its mail-order diabetic testing supplies. Allegedly, a handful of sister corporations, including a urine drug testing company, paid unlawful kickbacks to providers to induce referrals of urine drug tests and ended up paying judgments of $140 million.

Defective devices

There are also examples of medical companies selling defective devices. That was the case with St. Jude Medical, which paid $27 million to settle allegations that it knowingly sold defective heart devices to healthcare facilities that, in turn, implanted the devices into patients insured by federal healthcare programs. 

False Claims Act protocol

These fraud cases, which are a product of the False Claims Act, are often triggered by whistleblowers. These qui tam cases are sent directly to the DOJ, which decides whether the suit meets requirements. The claims are kept confidential while the government determines whether to pursue a lawsuit. The government has up to 60 days to review the suit. If and when the government moves forward with a qui tam action, the whistleblowers remain anonymous until the claim is resolved.

Healthcare fraud costs taxpayers and the federal government billions of dollars annually. If you witnessed healthcare fraud, an attorney can help you navigate the process and help ensure that you’re protected and compensated fairly.

Join a Free Healthcare Whistleblower Lawsuit Investigation

If you had this issue, fill out the form on this page or follow the link below for more information.

This article is not legal advice. It is presented for informational purposes only.

GET HELP – IT’S FREE

Join a Free Healthcare Whistleblower Lawsuit Investigation

If you qualify, an attorney will contact you to discuss the details of your potential case at no charge to you.

We tell you about cash you can claim EVERY WEEK! Sign up for our free newsletter.

One thought on Healthcare fraud cases reached $5 billion in 2021, thanks to the False Claims Act

  1. James Doherty says:

    I just want to know if it is Illegal to have policies that make people wear masks against the TITLE II OF THE CIVIL RIGHTS ACT 42 U.S.C. §2000a?? if so i want to file a complaint against my Doctors

Leave a Reply

Your email address will not be published. By submitting your comment and contact information, you agree to receive marketing emails from Top Class Actions regarding this and/or similar lawsuits or settlements, and/or to be contacted by an attorney or law firm to discuss the details of your potential case at no charge to you if you qualify. Required fields are marked *

Please note: Top Class Actions is not a settlement administrator or law firm. Top Class Actions is a legal news source that reports on class action lawsuits, class action settlements, drug injury lawsuits and product liability lawsuits. Top Class Actions does not process claims and we cannot advise you on the status of any class action settlement claim. You must contact the settlement administrator or your attorney for any updates regarding your claim status, claim form or questions about when payments are expected to be mailed out.