Fraud in the healthcare sector continues to be a major concern in the United States. According to the Health Care Fraud and Abuse Control Program Annual Report, healthcare fraud was by far the leading source of the False Claims Act settlements and judgments in 2021. In fact, more than $5 billion of the $5.6 billion collected in federal false claims and fraud cases involved healthcare industry entities–the department’s largest haul since 2014.

Healthcare fraud affects everyone. Reduced benefits, higher out-of-pocket costs, unnecessary procedures, and higher taxes are just a few of the consequences that occur when an individual or organization commits healthcare fraud. Whistleblowers must stay vigilant and report any suspicions. Here are the top three fraud and False Claim recoveries from 2021.

  1. $447.2 Million: Taro Pharmaceuticals USA, Inc., Sandoz Inc., and Apotex Corporation

In October 2021, three generic pharmaceutical manufacturers, Taro Pharmaceuticals USA, Inc., Sandoz Inc., and Apotex Corporation, agreed to pay a total of $447.2 million to resolve alleged violations of the False Claims Act arising from conspiracies to fix the price of various generic drugs. The Justice Department alleged that these conspiracies resulted in higher drug prices for federal healthcare programs and beneficiaries. According to the DOJ, all three manufacturers violated the Anti-Kickback Statute due to arrangements on price, supply, and allocation of customers with other pharmaceutical manufacturers of various generic drugs.

  1. $300 Million: Indivior

In April 2021, pharmaceutical manufacturer, Indivior, agreed to pay $300 million to resolve claims that it falsely and aggressively marketed its opioid addiction drug, Suboxone, resulting in improper use of state Medicaid funds. According to the DOJ, Indivior promoted the sale and use of Suboxone for unsafe, ineffective, and medically unnecessary purposes, including by claiming it was less susceptible to abuse. Additionally, the company took steps to fraudulently delay the entry of generic alternatives in order to control pricing. This settlement resolves six whistleblower suits pending in New Jersey and Virginia under the qui tam, or whistleblower, provision of the False Claims Act, which allows private citizens to bring civil actions on behalf of the United States and share in any recovery.

  1. Alere: $160 Million

In August 2021, diabetic testing supply company, Arriva Medical LLC and its parent company Alere Inc. agreed to pay $160 million to resolve allegations that the two companies made, or caused, claims to Medicare that were false. According to the settlement, Arriva, with Alere’s approval, regularly waived or simply didn’t collect Medicare copayments and sent new glucose meters at no cost to patients who weren’t yet eligible for reimbursable upgrades. The whistleblower, in this case, was an employee at an Arriva call center and is set to receive a whistleblower award of $28.5 million. 

These are just a few of the countless settlements that occurred in 2021. When corruption finds its way into the healthcare industry, it can be easy for these multi-billion dollar companies to take advantage of the system. As a result, consumers, healthcare systems, and government entities suffer the consequences of healthcare fraud that leads to diminished patient care, mistrust in the healthcare system, and misappropriation of publicly funded healthcare.

Our goal at DJO is to expose and report healthcare fraud wherever and whenever possible. We work with individuals to gain information, build a case, and fight for taxpayers’ justice. In doing so, we can protect the vulnerable and make the world a safer place.

If you suspect healthcare fraud in your organization, please contact us. DJO is comprised of a highly experienced team of whistleblower experts, lawyers, and even former whistleblowers, who strive to deliver the highest monetary reward for brave individuals who have valuable information that can expose fraud. If a whistleblower’s lawsuit is successful, the reward can be between 15% to 25% of the funds recovered. The False Claims Act also offers whistleblowers protection against job retaliation or wrongful termination. Do you have valuable information that can help bring fraud to light? Speak to our experts today.

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