January 20, 2020
DOJ recovers $2.6B in 2019 health care fraud judgments
The U.S. Department of Justice (DOJ) says it recovered $3 billion in fraud settlements and judgments in 2019 and $2.6 billion of that amount involved health care fraud cases.
The lawsuits involved drug manufacturers, hospitals, pharmacies, physicians, laboratories and makers of medical devices and involved claims of bribery, illegal pricing and price-fixing.
Opioid makers are common offenders
Many of the most significant recoveries involved manufacturers of opioids, including:
- $624 million: Actelion Pharmaceuticals US, Amgen, Astellas Pharma US, Alexion Pharmaceuticals, Lundbeck and US Worldmeds resolved claims that they illegally paid patient copays for pain relievers through sham foundations.
- $500 million: Reckitt Benckiser Group settled allegations that it, directly and indirectly, promoted the addictive pain reliever Suboxone to doctors who wrote prescriptions that were unsafe, ineffective or unnecessary.
- $195 million: Insys Therapeutics settled civil complaints that it paid kickbacks to physicians and nurse practitioners to prescribe Subsys, which is the brand name for Fentanyl.
- $95 million: Avanir Pharmaceuticals settled allegations that it provided kickbacks to encourage long-term care facilities to prescribe Neudexta for Alzheimer’s patients, even though it is not an approved use of the drug.
- $63.5 million: Inform Diagnostics, a pathology laboratory company, settled claims that it paid kickbacks to doctors over electronic health records systems and technology consulting services.
Whistleblowers were responsible for the majority of lawsuits
The DOJ says $2.1 billion of settlements are the result of lawsuits filed by whistleblowers under the False Claims Act. The government rewarded the individuals who exposed fraud and false claims, paying them $265 million in total.
This was the 10th straight year that the department’s civil health fraud judgments exceeded $2 billion, while recoveries now total more than $62 billion since Congress strengthened the False Claims Act in 1986.
