The Department of Justice announced yesterday a record recovery of $5.7 billion in false claims, $2.3 billion of which came from the healthcare industry. (The industry hardest hit by the DOJ this year was the financial industry.)
Almost half of that $2.3-billion sum came from Johnson & Johnson as part of a larger suit regarding off-label drug marketing, but post-acute care providers, hospitals and vendors also came under fire. Omnicare, a pharmaceutical provider and consulting firm based in Cincinnati, OH, allegedly paid kickbacks to nursing homes, resulting in a $120-million check. Home health provider Amedisys paid $150 million for allegedly billing for unnecessary home healthcare.
Hospitals, meanwhile, clocked in a total of $335 million. Halifax Hospital Medical paid $85 million to resolve claims of billing for improper referrals.
Community Health Systems paid almost $100 million for alleged improper inpatient admissions. Matt Organ, partner at Goldberg Kohn, the law firm representing the two whistleblowers who brought the case, hinted at alleged corporate pressure on physicians to meet the more profitable internal benchmarks for admittance. "I think that there are a number of people in the healthcare industry who have a growing concern about corporate pressure influencing medical decision-making," Organ told Modern Healthcare in August. "I think when this case gets a little bit of attention, people might recognize this may be happening at their medical facility and give them the courage to come forward."
CHS continues to maintain that its physicians and management behaved properly.
So how do these numbers stack up compared to previous years? Under the Obama administration, they're not far off. While O has been in office, payouts have ranged from $1.6 billion to $3.1 billion.
Interestingly, overall whistleblower action is down. Whistleblowers lodged 713 FCA complaints in 2014, down from 754 last year—the first year-over-year decline since 2007 (even if it's still the second-largest number in history).
More notably, the percent of payout stemming from whistleblower suits was down. In 2012, 70% of recovered funds was the result of whistleblower action; last year that number was 80%. In 2014, only about $3 billion of the total $5.7 billion, or about 52%, is a result of whistleblower action.
It's hard to say what the reason for this decline is, given the financial incentives inherent. Whistleblowers were paid out a total of $435 million for their contributions in 2014 alone, and some make a fortune: Louisiana internist William LaCorte has made $38 million in whistleblower payments after filing 12 False Claims lawsuits over the last two decades.
Here are the biggest stories in the healthcare industry this week:
Many of the new positions are arising from demands imposed by the ACA, researchers said.
Adeo LLC hopes to promote and distribute medical technologies developed by the Clinic and its partners that might not have come to light otherwise.
The second version of the ACA's online insurance marketplace rolled out on Saturday with few glitches.
PAs and NPs are growing in volume. How much longer will federal laws prevent them from practicing to the full scope of their abilities?
How do early adopters of electronic health records, big and small, really feel about the technology?
And here's what we were reading:
- A very interesting article in Modern Healthcare looks at why the industry should be talking seriously about the issue of net neutrality.
- The Washington Post gives Healthcare.gov a hilarious make-over to look like Buzzfeed, Drudge Report and others.
- Eric Topol at this year's Digital Health Conference had an interesting graphic on physician pressures: