False Claims Act Settlements Surpassed $2.9 Billion in Fiscal Year 2024

On January 15, 2025, the head of the Justice Department’s Civil Division announced that settlements and judgments under the False Claims Act surpassed $2.9 billion for the fiscal year ending September 30, 2024. This total includes 558 settlements and judgments, the second-highest number after last year’s record of 566, and reflects the filing of 979 qui tam lawsuits, the highest number in a single year. Since the False Claims Act was strengthened in 1986, total recoveries now exceed $78 billion.

Of the $2.9 billion reported for fiscal year 2024, more than $2.4 billion stemmed from qui tam lawsuits. Whistleblowers received over $400 million in relator shares for exposing fraud. The number of qui tam lawsuits filed has significantly increased since 1986, with over 18 new cases filed weekly in the past year.

Over $1.67 billion of the total amount related to the healthcare sector, including providers, pharmacies, pharmaceutical companies, and medical facilities. These cases often involved fraud within Medicare and Medicaid programs, and many included recoveries for state Medicaid programs as well. The Justice Department continued to target healthcare fraud, particularly in areas related to the opioid crisis, medically unnecessary services, and substandard care.

The Justice Department also pursued false claims in the Medicare Advantage (Part C) program, which is now the largest component of Medicare.

For additional details, the full announcement and notable case summaries are available here, and the Fraud Statistics Overview from October 1, 1986, through September 30, 2024, can be accessed here.

Compliance Perspective

Issue

In fiscal year 2024, healthcare fraud continued to be a leading source of False Claims Act settlements and judgments. Providing unnecessary medical services not only wastes taxpayer funds but can also expose patients to harmful procedures or cause them to miss out on potentially more effective treatments. The False Claims Act imposes treble damages and penalties on individuals who knowingly submit false claims or fail to pay money owed to the United States.

Discussion Points

Review your policies and procedures for preventing and reporting a false claim and for conducting a Triple Check Process to verify accuracy of Medicare claims. Ensure that your policies are reviewed at least annually and updated when new information becomes available.

Train all staff upon hire and at least annually on your compliance and ethics policies and procedures and on what can be considered a false claim. Provide training to appropriate staff on the Triple Check Process for ensuring accuracy of all Medicare Part A billing and supporting documentation before claims are submitted. Members of the compliance and ethics committee should periodically receive additional training on compliance and ethics issues in healthcare. Ensure that training sessions are documented and that documentation of employee participation is retrievable.

Conduct regular audits to ensure staff members are aware of their responsibility to report potential compliance violations and that they understand the steps to take, whether to their supervisor, the compliance officer, or via the anonymous hotline. Audit the Triple Check Process regularly to ensure its proper implementation each month before Medicare claims are submitted, and ensure that any identified irregularities are addressed and corrected promptly.

*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*

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