COMPARISON OF RECOVERIES (FY 2021) HEALTHCARE RECOVERIES V. ALL OTHER RECOVERIES $600 Million
ALL OTHER RECOVERIES HEALTHCARE RECOVERIES
$5 Billion
NOTEWORTHY SETTLEMENTS
Newly-filed qui tam complaints accounted for the vast majority of new civil fraud matters initiated in FY 2021, which is also typical of recent years. Whistleblowers filed 589 new qui tam lawsuits, which represented a substantial decrease over the prior year and is the lowest number of new qui tam lawsuits since 2010. Qui tam lawsuits accounted for more than $1.6 billion of the $5.6 billion recovered in civil enforcement matters. 39 The Appendix to our Healthcare Fraud & Abuse Review contains a detailed breakdown of key settlements from the past year, many of which are referenced below. HOSPITALS AND HEALTH SYSTEMS Hospitals and health systems resolved several notable cases, many of which related to alleged violations of the Stark Law or the Anti-Kickback Statute (AKS). Improper compensation arrangements with physician referral sources remained a key area of scrutiny, including arrangements where compensation allegedly exceeded fair market value (FMV) or accounted for the volume or value of physician referrals. 40 In one such case, a hospital agreed to pay over $18 million to resolve allegations that it impermissibly took into account the volume and value of certain physicians’ referrals when it repurchased shares from physician-owners aged 63 or older and then resold the shares to younger physicians. 41
Following the trend of more than a decade, resolutions in healthcare fraud cases accounted for the vast majority of all FCA recoveries in FY 2021. Of the $5.6 billion in civil fraud settlements and judgments, recoveries from matters involving the healthcare industry amounted to $5 billion (89%). 37 This is the 13th consecutive year that recoveries in federal civil healthcare fraud matters have exceeded $2 billion and is the largest recovery since FY2014. 38
39 The balance of the total civil fraud enforcement settlements and judgments for FY2021 was comprised, in significant part, of recoveries associated with opioid enforcement efforts. See https://www.justice.gov/ opa/pr/justice-department-s-false-claims-act-settlements-and-judgments-exceed-56-billion-fiscal-year. 40 https://www.justice.gov/opa/pr/northern-ohio-health-system-agrees-pay-over-21-million-resolve-false- claims-act-allegations; https://www.justice.gov/opa/pr/prime-healthcare-services-and-two-doctors-agree- pay-375-million-settle-allegations-kickbacks. 41 https://www.justice.gov/opa/pr/flower-mound-hospital-pay-182-million-settle-federal-and-state-false- claims-act-allegations.
37 https://www.justice.gov/opa/pr/justice-department-s-false-claims-act-settlements-and-judgments-exceed- 56-billion-fiscal-year. 38 https://www.justice.gov/opa/pr/justice-department-recovers-over-22-billion-false-claims-act-cases-fiscal- year-2020.
HEALTHCARE FRAUD & ABUSE REVIEW 2021 BASS, BERRY & SIMS | 7
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