The Department of Justice recently reported that in fiscal year 2021, it received more than $5.6 billion in settlements and judgments. Of that total, over $5 billion relates to matters that involved the health care industry. Providers from all across the health care industry were included in the Justice Department’s efforts, including hospitals, drug and medical device manufacturers, hospices, physicians, managed care providers, pharmacies, and laboratories.
In its February 1, 2022, press release, the Justice Department details health care fraud enforcement efforts focused on the Medicare Advantage program (Medicare Part C). Specifically, the Justice Department focused on health plans and providers that allegedly manipulated the Centers for Medicare and Medicaid Service’s risk adjustment process. The Justice Department alleges that the providers submitted unsupported diagnosis codes, which made their patients appear sicker than they were in reality. Additional details of settlements and judgments involved providers that allegedly billed federal health care programs for medically unnecessary services or services that were not rendered as billed.
Now in the midst of the COVID-19 pandemic, the Justice Department reported that it increased its focus on the misuse of critical pandemic relief monies. One example cited in the press release included improper payments made by a physician and his medical practice under the Paycheck Protection Program (“PPP”). The physician and his medical practice paid the Justice Department $70,000 to resolve allegations under the False Claims Act and the Financial Institutions Reform, Recovery and Enforcement Act due to the physician falsely certifying statements in an application for a second PPP loan.
For questions about this alert, or the False Claims Act, please contact the authors of this alert. Also, visit the Steptoe & Johnson Health Care Team on LinkedIn to keep up with the latest developments in health care law.