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Healthcare Industry Top False Claims During 2018

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Healthcare fraud is an umbrella term that covers numerous crimes committed by doctors, pharmacists, nurses, and other healthcare professionals. These offenses cost taxpayers billions of dollars each year. Federal investigators from the attorney general’s office make it a priority to swiftly bring healthcare fraudsters to justice.

Last year proved especially lucrative in recouping billions of dollars misspent because of fraudulent healthcare claims. Several companies paid out millions in 2018 to settle allegations of defrauding government healthcare programs.

Are you or someone you know facing fraud charges? Contact defense attorney Brett Podolsky today >>

2018 Healthcare Fraud Statistics

The federal attorney general’s office announced recently that 2018 was the ninth year in which healthcare fraud settlements and judgments topped more than $2 billion. In fact, investigators recouped more than $2.8 billion total in healthcare fraud claims. Out of that amount, more than $2.5 billion was directly linked to fraudulent and improper claims made to government healthcare providers like Medicare, Medicaid, and Tricare.

The attorney general’s office investigated these crimes under the False Claims Act. This act makes it illegal to defraud state and federal government health insurance programs. Thanks to the efforts of the office’s investigators, numerous states also recouped millions that were fraudulently billed to Medicaid.

The attorney general announced that these healthcare fraud recoveries demonstrate the cost that taxpayers incur on a yearly basis because of these crimes. In particular, the investigations found that some of the largest acts of fraud were committed by those in the drug and medical device industries. People found guilty of these offenses many times have to pay back both the state and federal government for fraudulent claims.

Moreover, 2018 was the largest healthcare fraud enforcement action taken by the attorney general’s office in recent history. Last year saw more than 600 healthcare professionals including doctors, nurses, and other licensed industry personnel being charged with healthcare fraud.

The total fraud amount committed by everyone who was investigated and charged topped more than $2 billion. A significant number of defendants were additionally charged with improperly dispensing or prescribing opioids and other controlled pharmaceuticals.

Examples of Healthcare Fraud Committed in 2018

Numerous companies that operate in the healthcare industry as a whole found themselves targeted and brought to justice because of the attorney general’s healthcare fraud investigations. Many of these companies were forced to pay back money that they received from the state and federal governments because of improper or fraudulent claims. Several were also found guilty of participating in cover-ups to hide their crimes.

AmeriSource Bergen

One of the largest healthcare fraud recoveries made in 2018 involved the company AmeriSource Bergen. This company as well as its subsidiaries were made to pay back more than $625 million to the federal government.

The government charged the company and its subsidiaries of purposely circumventing safeguards that were put in place by the federal government to preserve the country’s drug supply. AmeriSource Bergen was accused of repackaging certain drugs that are used by cancer patients. Out of that $625 million that was recovered from the company, more than $581 million was paid directly to the federal government. More than $43 million was paid back to the Medicaid program.

Actelion Pharmaceuticals U.S.

The company Actelion Pharmaceuticals U.S. was made to pay back more than $360 million to the government after it was charged with engaging in healthcare fraud. Specifically, the attorney general’s office accused Actelion Pharmaceuticals U.S. of illegally paying the copays of thousands of Medicare patients who used the hypertension drugs made by the company.

Investigators say the company used the services of a charity known as Caring Voice Coalition Inc, which operates as a tax-exempt patient financial assistance charity, to illegally pay for the copays of patients who used a variety of expensive hypertension drugs and products like:

  • Tracleer
  • Ventavis
  • Veletri
  • Opsumit

The charity unwittingly served as a conduit for Actelion Pharmaceuticals U.S. to carry out its fraudulent billing.

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DaVita Inc.

A subsidiary of DaVita Inc. was made to pay the government back more than $270 million. This amount was intended to settle claims that the company purposely provided inaccurate information to Medicare Advantage about Medicare patients. The wrong information led to the government being fraudulently billed and subsequently paying out inflated payments to DaVita Inc.

Health Management Associates

Health Management Associates paid back more than $260 million to the federal government to settle claims that it gave kickbacks to doctors and defrauded Medicare and other government health insurance programs. Prosecutors claimed the company paid physicians in exchange for patient referrals. It also submitted inflated emergency department claims to Medicare, Tricare, and Medicaid.

Beaumont Hospital

Detroit-based Beaumont Hospital paid back $84.5 million to the federal government for allegations of kickbacks given to doctors and other healthcare providers. These allegations came to light as the result of whistleblower lawsuits brought by four former employees.

The kickbacks were paid between 2004 and 2012. The hospital and leaders at three of its branches were charged with giving free or discounted office space to physicians in exchange for patient referrals. These kickbacks violated the Anti-kickback Statute and Stark Law.

Your Rights When Facing Healthcare Fraud Charges

While healthcare fraud is a serious crime with which to be charged, you do have rights as a defendant in one of these cases. For example, you have the right to a fair and speedy trial. You also have the right to provide evidence that could exonerate you during a trial.

It is important that you hire a skilled lawyer with experience defending clients against healthcare fraud charges to represent you. Your attorney can explain the charges in their entirety to you. He can also make sure that your case is presented in a clear and fair manner in court. With an attorney’s help, you and your company could avoid paying back millions or more and also avoid the damage that can come with being found guilty of healthcare fraud.

Healthcare fraud is a crime that costs taxpayers billions of dollars each year. It compromises the reputation and business practices of companies found guilty of engaging in this crime. You could successfully defend yourself and your company in a healthcare fraud case by hiring a skilled healthcare fraud attorney to represent you today.

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