In its Semi-Annual Report to Congress, OIG announced that expected recoveries for FY 2012 are $6.9 billion.  The $6.9 billion consists of $923.8 million in audit receivables and $6 billion in investigative receivables.  The investigative receivables include criminal restitution, settlements pursuant to False Claims Act (FCA) cases and Civil Monetary Penalty (CMP) actions, and other administrative recoveries related to provider self-disclosure matters.  In addition to the monetary recoveries, OIG excluded 3,131 individuals and entities from participating in Federal health care programs.

At least half of the $6 billion in investigative receivables stems from the government’s $3 billion settlement with GlaxoSmithKline for alleged off-label marketing and promotion of several drugs.  Other notable FCA settlements include:

  • McKesson Corporation – $187 million FCA settlement for alleged inflation of prescription drug prices;
  • AmMed Direct, LLC – $18 million FCA settlement for allegedly fraudulent practices with its diabetic testing supplies;
  • AHS Hospital Corporation et al. – $8.9 million FCA settlement for allegedly improper admission of patients to the hospital rather than placing them on observation and evaluation status;
  • Walgreens – $7.9 million FCA settlement for alleged kickbacks to beneficiaries to induce them to transfer their prescriptions to Walgreens; and
  • Hospice Care of Kansas – $6.1 million FCA settlement for alleged submission of false claims for services provided to beneficiaries that did not meet hospice eligibility criteria.

OIG also noted that during this reporting period it settled several cases under its CMP authority, which essentially mirrors the FCA, for a total recovery of $6.7 million.  Additionally, OIG recovered $53.3 million through its self-disclosure protocol, most of which is attributed to one settlement with Tenet Healthcare Corporation for $42,750,000.

Our Insight. Your Advantage.  On page 38 of this report, OIG displays two charts that summarize the investigative outcomes over the last five years.  The first chart shows that OIG’s civil and criminal actions went from a total of 917 in FY 2008 to 1,145 in FY 2012.  The second chart shows that total receivables in FY 2008 were $3.2 billion, compared to total projected receivables in FY 2012 of $6 billion.  Clearly, the government’s civil and criminal enforcement efforts are not subsiding and its audit activities are also on the rise.  Most likely, monetary recoveries for FY 2013 will be greater than this year’s projected recoveries of $6 billion.