NASHVILLE, Tenn.--(BUSINESS WIRE)--With a near doubling of whistleblower lawsuits filed in the past five years and continued significant fraud recoveries by the government, healthcare organizations should be prepared to face increasing scrutiny in 2014, according to “Healthcare Fraud and Abuse Review 2013” published by law firm Bass, Berry & Sims PLC.
The government recovered a total of $4.3 billion in all fraud, abuse and audit recoveries in fiscal 2013, according to a recent announcement by the U.S. Department of Justice. Whistleblowers received $324.2 million from those recoveries, according to the Justice Department. A detailed discussion of the government’s recoveries in fiscal year 2013 is provided in the Review.
“Heightened whistleblower activity under the False Claims Act is fueling the government’s fraud recoveries, even as more providers are increasingly willing to litigate these issues with the government,” said Matthew Curley, a member of the firm’s Healthcare Fraud Task Force. “Healthcare organizations can expect continued scrutiny in 2014. They should be increasingly focused on ensuring compliance with relevant healthcare fraud laws and regulations, especially involving their physician relationships.”
The Review, which is published annually by Bass’ Healthcare Fraud Task Force, also details the impact of cases involving major fraud and abuse laws, including the Stark Law, which prohibits physician self-referrals, and the Anti-Kickback Statute, and covers last year’s $237 million judgment against Tuomey Health Care stemming from a 2005 False Claims Act complaint filed by a physician whistleblower.
“One of the most significant issues to watch in 2014 will be the ramifications of the government’s recent $85 million settlement with Halifax Medical Center in Florida,” said Brian Roark, head of the firm’s Healthcare Fraud Task Force. “The theory of liability pursued by the government marks a dramatic shift in applying the Stark Law to Medicaid, and not just Medicare claims. Expansion of the Stark Law to Medicaid claims certainly will result in heightened risk under the False Claims Act for providers.”
Other key takeaways from the Review include:
- During the last five years, new lawsuits filed by whistleblowers under the False Claims Act have nearly doubled, with more than 750 new suits filed in fiscal year 2013.
- The Medicare Fraud Strike Force filed charges against 274 individuals or entities, initiated 251 criminal actions and secured $333 million in investigative receivables.
- Courts grappled with many complex issues under the False Claims Act in 2013 – such as pleading standards, the public disclosure bar, and the expansion of FCA liability to Medicaid claims allegedly tainted by violations of the Stark Law.
Each year, the firm’s Healthcare Fraud and Abuse team conducts a comprehensive review of major developments in healthcare fraud and abuse litigation in the United States. The “Healthcare Fraud and Abuse Review” covers the year’s noteworthy judgments and settlements across all sectors of healthcare: hospitals and health systems, physicians, health plans, long-term care organizations, and pharmaceuticals and medical device companies.
Download the “Healthcare Fraud and Abuse Review” here.
About the Bass, Berry & Sims Healthcare Fraud Task Force
The Bass, Berry & Sims Healthcare Fraud Task Force represents healthcare providers in fraud and abuse matters, including responding to whistleblower cases and governmental inquiries by the U.S. Department of Justice, U.S. Attorneys’ Offices, the Office of Inspector General of the U.S. Department of Health and Human Services and other agencies.
About Bass, Berry & Sims
Bass, Berry & Sims is one of the nation’s premier law firms with more than 200 attorneys representing numerous publicly traded companies and Fortune 500 businesses. Based in Nashville, with offices in Washington, D.C., and Knoxville and Memphis, Tenn., Bass, Berry & Sims has been involved in some of the largest and most significant business transactions and litigation matters in the country. For more information, visit www.bassberry.com or follow us on Twitter: @BassBerrySims.
