DOJ’s False Claims Act Enforcement “State of the Union”
July 22, 2021. At the American Health Law Association’s Annual Meeting during the last week of June 2021, Michael Granston, Deputy Assistant Attorney General for the Department of Justice’s (DOJ) Civil Division, reiterated the DOJ’s increased focus on prosecuting healthcare fraud under the False Claims Act.
In his remarks, he cited this statistic: the DOJ “opened over 900 new matters in 2020, including 580 new health fraud matters.” Of 366 False Claims Act-related cases the DOJ settled last year, 265 cases were healthcare-related. Areas of interest to the Justice Department include: opioid-related fraud, COVID-19 relief fund fraud, electronic health record misuse, Medicare’s managed care program manipulation, and senior citizen abuse.
Examples of healthcare fraud prosecuted under the False Claims Act in 2020 include: kickbacks to physicians for prescribing drugs; recommending specific durable medical equipment, suppliers, sleep labs, and other facilities; and patient referrals. Knowingly submitting false claims to the Medicare, Medicaid, TRICARE, VA, and FEHB programs constitutes fraud. Under the False Claims Act, whistleblowers called qui tam relators can bring allegations of fraud to the government’s attention and can receive between 15-30% of the government’s recovery.