On Tuesday, the OIG released its Semiannual Report to Congress, which stated that expected recoveries for fraud and abuse activities total $2.77 billion in the first half of fiscal year 2016. This represents a gain of almost $1 billion when compared to the first half of fiscal year 2015. The report, which covers the time period of October 1, 2015 through March 31, 2016, stated that the $2.77 billion consisted of approximately $554.7 million in expected recoveries from audits and roughly $2.22 billion in expected recoveries from government investigations. Some recoveries are expected as settlement amounts may have been agreed to in principle, but the parties are still working on the details of the settlement agreement.
FCA civil penalties to increase substantially under proposed rule
Earlier this week, the Railroad Retirement Board (RRB) became the first federal agency to promulgate an interim final rule implementing provisions of the Bipartisan Budget Act of 2015 intended to index civil penalties assessed under certain statutes to inflation. The RRB’s proposed final rule would double civil penalties assessed under the False Claims Act (FCA).
Fifth Circuit upholds limits on attorneys’ fees in FCA whistleblower suit
A decision by the Fifth Circuit Court of Appeals may help FCA defendants challenge relators’ claims for attorneys’ fees, especially where relators’ counsel fails to keep adequate time records distinguishing between work for which the relators recovered an award and work where they did not.
Government healthcare fraud-and-abuse recovery drops to $2.4 billion in FY 2015
In a report released on February 26, 2016, the federal government announced that it recovered $2.4 billion through its Health Care Fraud and Abuse Control Program (HCFAC) during FY 2015. The $2.4 billion is almost $1 billion lower than the recovery of $3.3 billion in FY 2014. Over the last three years, the return on investment (ROI) for the HCFAC program is $6.10 returned for every $1.00 expended. Qui tam litigation accounted for $452 million of the recovery by the federal government.
CMS issues anticipated Medicare overpayments final rule; relaxes initial proposals
On February 11, 2016, CMS issued a final rule clarifying the requirement of § 1128J(d) of the Social Security Act (created by § 6402(d) of the Affordable Care Act) that health care providers must report and return overpayments within 60
New trends in statistical sampling
Although the trend of ever-larger FCA recoveries by the DOJ is not new, what is new is a recent trend by federal district courts to make it even easier for the government to prove cases against healthcare defendants by allowing
Challenge dropped to dismissal of allegations of pharmacy-reward fraud
A relator is dropping his appeal of a district court decision that granted a motion to dismiss FCA claims against CVS. Procedural deficiencies were raised with relator’s appeal, including missing the filing deadline for his appeal in the U.S. Court