Fraud, Abuse Landscape Changing: Review

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The Bass Berry & Sims 2015 Healthcare Fraud and Abuse Review says that only a fraction of the $3.6 billion in Fiscal Year 2015 civil fraud recoveries involved matters concerning the drug industry, while a significant amount of them involved whistleblower actions raising issues of medical necessity and improper financial relationships between hospitals and doctors. This was the 11th straight year in which recoveries exceeded $1 billion, the report says.

It notes that the year’s fraud headlines were noteworthy as much for legal developments and Justice Department pronouncements as for the healthcare fraud recovery amount.

Although 2015 was the fifth straight year in which whistleblowers filed more than 600 new lawsuits, the yearly total of 632 new suits was more than 10% lower than in the previous year. Whistleblowers recovered a record-breaking $598 million as their share of the proceeds in qui tam judgments and settlements in FY 2015.

The report also references the 9/2015 “Yates Memo” in which deputy attorney general Sally Yates formalized a message that department officials have forecasted for several years: that it will seek to hold individuals who are responsible for corporate wrongdoing accountable for their actions.

Details in the report cover a number of cases involving FDA.

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