During the 2021 fiscal year, the Justice Department's FCA settlements and judgments exceeded $5.6 billion. The bulk ($5 billion) of these concerns health care industry fraud. Whistleblowers filed 598 qui tam lawsuits in 2021. Here are some 2021 examples to answer, "what are the best whistleblower lawsuits?"
Fighting the opioid epidemic - Thousands of Americans die from opioid overdoses yearly. Parties responsible for triggering and inflaming the epidemic were held accountable. Prescription opioid manufacturer, Indivior, agreed to pay $209.3 million to the federal government to resolve civil allegations that the company engaged in the promotion of their opioid-addiction treatment drug called Suboxone to physicians who were giving out the prescriptions for uses that were not acceptable. The manufacturer further made false and misleading claims about their medication, indicating it was less likely to be misused or abused.
Opioid manufacturer Purdue agreed to a $2.8 billion bankruptcy claim to resolve its civil allegations. The company was accused of providing kickbacks to physicians, specialty pharmacies, and an electronic health records developer to expand the use of its opioid products. Members of the Sackler family who sat on the board and were shareholders in the company paid an additional $225 million in connection to a new marketing program they had approved that increased the marketing of OxyContin to high-volume prescribers, which fanned the flames of the opioid epidemic.
Medicare Part C fraud - In this program, healthcare providers and plans are paid based on various risk factors that impact the provider's expenditures. The department found wrongdoers manipulating the risk adjustment system through the submission of unsupported diagnosis codes to make patients appear more ill than they actually were. Sutter Health paid a $90 million settlement to resolve allegations it submitted false diagnosis codes to inflate its payments. Kaiser Foundation Health Plan paid $6.3 million for its similar fraudulent activities.
Unlawful kickbacks - In the healthcare industry, kickbacks threaten to subvert medical decision-making and increase costs for us all. Arriva, a mail-order diabetic testing supply company, paid $160 million for kickbacks to Medicare beneficiaries by providing free medical devices and not making reasonable efforts to collect copayments for testing supplies.
Daniel McCollum paid $140 million for paying unlawful kickbacks to providers in an effort to get them to use his urine drug tests over competitors. Athenahealth Inc, an electronic health records vendor, paid $18.25 million for its practice of inviting potential clients to all expenses paid sporting, recreational, and entertainment events. Taro, Sandoz, and Apotex paid over $400 million for paying and receiving compensation as part of a drug price-fixing conspiracy.
Unnecessary medical services - Medical providers and health care programs were under scrutiny for providing unnecessary medical services and services not rendered as billed in 2021. SavaSeniorCare LLC paid $11.2 million for aggressively targeting businesses to use rehabilitation therapy services for their Medicare patients that were unneeded, unwarranted, and administered by unskilled staff.
Alere paid $48.75 million for billing for and causing others to bill Medicare for defective rapid point-of-care devices used by Medicare beneficiaries. Patients used the devices to monitor blood coagulation when using anticoagulant drugs. Apria Healthcare LLC agreed to pay $40.5 million for the submission of false claims for the rental of expensive non-invasive ventilators to Medicare beneficiaries who did not use or need to use the devices.
St. Jude Medical Inc. paid out $27 million for allegations that it knowingly sold faulty implantable heart devices and did not disclose serious health risks in connection with premature battery depletion in the devices. Regency, Inc. agreed to pay up to $20.3 million to settle claims that it falsified documents to bill federal healthcare programs for medically unnecessary equipment.
Procurement fraud - Committing fraud related to the government purchase of goods and services is a top priority of the Justice Department. Navistar Defense LLC paid $50 million for allegations that it defrauded the U.S. Marine Corps, causing it to enter into an agreement for a suspension system component for armored vehicles at inflated prices. Insitu Inc. paid $25 million for knowingly submitting false cost and pricing data for contracts with the U.S. Special Operations Command and the Department of the Navy to supply and run Unmanned Aerial Vehicles.
In other cases, the department went after government contractors that failed to comply with contract requirements. For example, United Airlines paid $32.1 million for failure in its contract with the U.S. Postal Service to deliver international mail on behalf of the government. Cognosante LLC paid $18.9 million for using unskilled labor and overcharging the government. AAR Airlift paid $11 million for its failure to maintain nine helicopters and for erroneously certifying the helicopters were fully mission capable.
Kickbacks on government contracts were also under scrutiny. Level 3 Communications LLC paid $12.7 million for taking kickbacks from two subcontractors for more favorable treatment on government contracts. Schneider Electric Buildings Americas Inc. paid over $9 million after allegations that a senior project manager solicited kickbacks from subcontractors and defrauded the government for design costs.
Covid-related fraud - The misuse of pandemic relief funds has drawn the critical eye of the Justice Department. Improper payments and misuse of Paycheck Protection Program (PPP) funds included businesses that fraudulently claimed they had not received a PPP loan. Dr. Walia falsely certified on behalf of his practice that the medical practice had not received a previous loan. He had to repay the loan and paid $70,000 under the FCA.
Sextant Marine Consulting LLC, a duct cleaning company, paid $30,000 for a second improperly obtained PPP loan. Finally, Seth A. Bernstein, a jet charter company owner, paid $287,055 for using PPP funds for personal expenses unrelated to his business.