Dive Brief:

• The Department of Justice recorded over $2.9 billion in settlements and judgments under the False Claims Act in 2024, with the majority of settlements coming from healthcare.
• Healthcare settlements totaled $1.67 billion. The money will go toward restoring defrauded federal healthcare programs, including Medicare, Medicaid and the military health program Tricare, according to Wednesday’s release.
• The DOJ once again said fraud enforcement in Medicare Advantage is of “critical importance.” Concerns about MA fraud have grown in recent years as the program has increased in popularity.

Dive Insight:

The FCA seeks to hold companies and individuals accountable for knowingly and falsely claiming money, or knowingly failing to pay funds owed to the U.S. government. For the past several years, the majority of federal FCA enforcement has centered on healthcare, as regulators have attempted to crack down on fraud.

In a news release, the DOJ said many of its investigations last year targeted providers that billed federal healthcare programs for medically unnecessary services and substandard care, or engaged in referral kickback schemes.

Community Health Network, for example, paid more than $300 million after the government found physicians were awarded referral-based bonuses, in violation of the Stark Law. The rule aims to decrease conflicts of interest and protect patients from receiving unnecessary care by barring healthcare providers from referring patients to...

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