Consistent with the trend in prior years, 2022 saw government enforcement agencies taking aim at fraud and false claims in healthcare. As the cost of healthcare rises along with its share of the U.S. economy, the enforcement focus on healthcare fraud is likely to accelerate. And, as always, the role of whistleblowers will be critical, as demonstrated by the dominance of cases originated by whistleblowers under the qui tam provisions of the False Claims Act on this 2022 Healthcare Fraud Top Ten. This year also stands out as a banner year for recoveries in declined cases – cases where the whistleblower proceeds without the government’s intervention – demonstrating the importance and perseverance of whistleblowers in recovering public dollars lost to fraud.
The majority of the recoveries on this list involve allegations of violations of the Anti-Kickback Statute, a federal law that prohibits medical providers from paying or receiving kickbacks, remuneration, or anything of value in exchange for referrals of patients who will receive treatment paid for by government healthcare programs such as Medicare and Medicaid. There are also notable settlements involving other government healthcare programs and private insurance, and cases with less commonly seen fraud theories involving the Medical Loss Ratio, secondary payor issues, and offshoring of services.
Here are the top ten healthcare recoveries of 2022 by the numbers:
For the past several months, a coordinated digital campaign has targeted community archivists in Bangladesh who document and preserve audiovisual material related to the July 2024 Student-People’s...