Fraud Tied to Government Health Care Programs Constitutes the Majority of DOJ’s 2016 False Claims Act Recoveries

In 2016, the United States Department of Justice (DOJ) had the third-largest year for False Claims Act (FCA) recoveries totaling more than $4.7 billion. Over the past few years, the DOJ has taken a position targeting the health care industry, and the trend continued as $2.5 billion of the 2016 recoveries came from investigations involving fraud, physician compensation, medically unnecessary procedures, misconduct, and kickbacks. The largest recoveries came from drug and device companies. Hospitals, outpatient clinics, nursing homes, laboratories, and physicians also contributed to a sizable amount of the recoveries. Whistleblower lawsuit recoveries were high. Additionally, 2016 saw an increase in settlements by individuals after the DOJ vowed greater individual accountability for fraud.

Looking to the future in 2017 and beyond, the possibility of the new administration repealing or dramatically amending the Affordable Care Act (ACA) and changing the composition of the Supreme Court will impact the DOJ’s enforcement activities going forward.