The Department of Justice (DOJ) announced this week that it collected another $4.7 billion during FY 2016 under the False Claims Act (FCA). This was the third largest haul in history, bringing total recoveries since FY 2009 up to $31.3 billion.
Although DOJ did not say it directly, there seems no end in sight to huge recoveries. The sleeping statistic is the number new matters initiated. Although given less prominence than the total of yearly collections, the number of new matters is the source of future recoveries because large verdicts or settlements often take years to achieve. That means part of this year’s recovery depended upon new matters filed in prior years. In that sense, the number of new matters takes on a kind of delayed fuse effect.
In its announcement, DOJ reported 702 qui tam matters were initiated in FY 2016 – an average of 13.5 every week. In addition, DOJ initiated 143 false claims investigations not based on qui tams — for a total of 845 new matters. Although only some actions produce a recovery, the sheer volume of new matters demonstrates the potential for future recoveries. This point becomes clearer when the number of number new matters is compared to prior years. The total of 845 in FY 2016 was the second highest in history, with FY 2013 taking first place at 856 new matters. Moreover, the qui tam total in 2016 is the third time in history that the number of qui tams has surpassed 700. Things certainly have come a long way from FY 1987 when only 30 qui tam matters were initiated.
All this means that compliance and vigilance against fraud remains crucial in the healthcare industry because, regardless of what happens to healthcare reform, aggressive enforcement against fraud will continue. After all, what stakeholder in the healthcare industry is in favor of fraud?
A couple of other points of interest from the announcement:
The majority of this year’s recovery, a total of $2.5 billion, came from the health care industry, including drug companies, medical device companies, hospitals, nursing homes, laboratories, and physicians. This was the seventh consecutive year of health care fraud recoveries exceeded $2 billion.
Consistent with the policy initiative announced in the Yates memorandum on individual accountability for corporate wrongdoing, DOJ announced the names of some individuals who were here held personally responsible for paying recoveries under the FCA and the amounts that they were required to pay.
In addition to federal recoveries, false claims actions often result in additional recoveries for states because of healthcare expenses paid under Medicaid.
Other areas of recovery under the FCA besides healthcare include the financial industry and government contracting.