The U.S. Department of Justice (DOJ) recently announced that it recovered more than $2.68 billion from False Claims Act cases in fiscal year 2023. 2023 was also the year of the highest number of settlements and judgments in a single year, with the government and whistleblowers being party to 543 total.

Of the $2.68 billion in settlements, $2.3 billion resulted from a total of 712 lawsuits filed under the qui tam provisions of the False Claims Act. The qui tam provisions of the FCA allow individuals with evidence of fraud being committed against the government to file a lawsuit on behalf of the United States. As a reward for coming forward and reporting the fraud, whistleblowers can receive up to 30% of the total money recovered.

Below are examples of FCA violations the DOJ pursued last year.

Healthcare Fraud

Of the $2.68 billion in False Claims Act settlements and judgments reported by the DOJ in 2023, over $1.8 billion were related to matters that involved the healthcare industry. One example was the continuation of pursuing fraud related to the Medicare Advantage Program. Here the DOJ made allegations that organizations had knowingly submitted or caused the submission of inaccurate information or knowingly failed to correct inaccurate information about the health status of beneficiaries enrolled in their plans to increase reimbursement. The DOJ managed to secure settlements with Cigna Group for $172 million and Martin’s Point Health Care for $22.5 million, while also continuing litigation on a number of other cases involving the Medicare Advantage Program.

Opioids

In 2023, the DOJ also continued its pursuit of health care providers, pharmaceutical companies, pharmacies, and other entities that played a role in contributing to and exacerbating the opioid crisis. In one case, the DOJ intervened in a whistleblower lawsuit brought by Baron & Budd against Rite Aid Corporation, alleging that Rite Aid filled unlawful prescriptions in violation of the False Claims Act and the Controlled Substances Act. The complaint alleges that Rite Aid knowingly filled unlawful prescriptions for controlled substances that lacked a legitimate medical purpose, were not for a medically accepted indication, or were not issued in the usual course of professional practice. The unlawful prescriptions included prescriptions for excessive quantities of opioids such as oxycodone and fentanyl.

Kickbacks

Kickbacks paid or received by health care providers taint medical decision-making, increase health care costs, and undermine the integrity of federal health care programs. For example, kickbacks can influence doctors to prescribe certain drugs not because they are the best treatment but because the doctor is receiving bribes from the drug manufacturer.

In one 2023 kickback case, the DOJ announced a resolution with Modernizing Medicine (ModMed) for kickbacks related to electronic health records (EHR). In the resolution, ModMed agreed to pay $45.4 million to resolve allegations that it improperly solicited and received kickbacks from a lab company in exchange for recommending and arranging for ModMed’s users to utilize the lab company’s pathology lab services, conspired with the lab company to improperly donate ModMed’s EHR technology to health care providers, and paid kickbacks to its customers to recommend ModMed’s technology and refer potential customers to ModMed.

About Us

Baron & Budd’s whistleblower representation team has more than 40 years of experience representing dozens of clients in government fraud cases. They have returned over $6.0 billion to federal and state agencies with whistleblower recovery shares as high as 50%.