For the first time in recent history, the previous year's healthcare fraud headlines were noteworthy as much for legal developments and U.S. Department of Justice (DOJ) pronouncements as they were for the healthcare fraud recovery haul by the government.
To be sure, DOJ enjoyed yet another banner year of civil and criminal healthcare fraud enforcement results. During the fiscal year ending September 30, 2015 (FY 2015), the federal government racked up nearly $3.6 billion in civil fraud recoveries, marking the eleventh straight year in which such recoveries exceeded $1 billion.
Nearly $2 billion of last year's civil recoveries related to matters involving false claims against the federal healthcare programs in violation of the False Claims Act (FCA). During the last five years, civil recoveries involving the federal healthcare programs have exceeded $12.5 billion. A significant amount of last year's civil recoveries involved qui tam actions raising issues of medical necessity and improper financial relationships between hospitals and doctors. In contrast to years past, only a fraction of the recoveries involved matters concerning the pharmaceutical industry.
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