The Department of Justice obtained more than $3.5 billion in settlements and judgments from civil cases involving fraud and false claims against the government in the fiscal year ending Sept. 30, and $1.9 billion came from companies and individuals in the healthcare industry.
The total marks the fourth year in a row that the department has exceeded $3.5 billion in cases under the False Claims Act (FCA), and it brings total recoveries from January 2009 to the end of the fiscal year to $26.4 billion, according to Benjamin C. Mizer, JD, principal deputy assistant attorney general and head of the Justice Department’s Civil Division.
Two of the largest healthcare recoveries this past year were from DaVita Healthcare Partners, the leading provider of dialysis services in the United States. DaVita paid $450 million to resolve allegations that it knowingly generated unnecessary waste in administering the drugs Zemplar and Venofer to dialysis patients, and then billed the government for costs that could have been avoided. DaVita paid an additional $350 million to resolve claims that it violated the FCA by paying kickbacks to physicians to induce patient referrals to its clinics. DaVita has its headquarters in Denver and has dialysis clinics in 46 states and the District of Columbia.
Hospitals were involved in nearly $330 million in settlements and judgments this past year. A cardiac nurse and a healthcare reimbursement consultant filed a qui tam suit against hundreds of hospitals that were allegedly implanting cardiac devices in Medicare patients contrary to criteria established by the Centers for Medicare and Medicaid Services with cardiologists, professional cardiology societies, cardiac device manufacturers, and patient advocates. The department settled with nearly 500 of these hospitals for a total of $250 million, including $216 million recovered in the past fiscal year.
Several settlements involved violations of the Stark Law. Hospitals settling false claims involving Stark violations include Adventist Health System, an organization that operates hospitals and other healthcare facilities in 10 states, for $115 million; North Broward Hospital District, a special taxing district of Florida that operates hospitals and other healthcare facilities in Broward County, FL, for $69.5 million; and Georgia hospital system Columbus Regional Healthcare System and Andrew Pippas, MD, for $25 million plus contingent payments up to an additional $10 million. The Adventist settlement also involved allegations of miscoding claims to obtain higher reimbursements for services than allowed by Medicare and Medicaid.