The U.S. Department of Justice just published its 124 page Annual Report of the Departments of Health and Human Services and Justice – Health Care Fraud and Abuse Control Program FY 2020.

The Annual Report of the Attorney General and the Secretary detailing expenditures and revenues under the Health Care Fraud and Abuse Control Program for fiscal year 2020 is provided as required by the Social Security Act.

During Fiscal Year 2020, the Federal Government won or negotiated more than $1.8 billion in health care fraud judgments and settlements, in addition to other health care administrative impositions.

Because of these efforts, as well as those of preceding years, almost $3.1 billion was returned to the Federal Government or paid to private persons in 2020. Of this $3.1 billion, the Medicare Trust Funds received transfers of approximately $2.1 billion during this period, in addition to the $128.2 million in Federal Medicaid money that was similarly transferred separately to the Treasury due to these efforts.

In 2020, the Department of Justice opened 1,148 new criminal health care fraud investigations. Federal prosecutors filed criminal charges in 412 cases involving 679 defendants. A total of 440 defendants were convicted of health care fraud related crimes during the year.

Also, in 2020, DOJ opened 1,079 new civil health care fraud investigations and had 1,498 civil health care fraud matters pending at the end of the fiscal year.

Federal Bureau of Investigation (FBI) investigative efforts resulted in over 407 operational disruptions of criminal fraud organizations and the dismantlement of the criminal hierarchy of more than 101 health care fraud criminal enterprises.

In 2020, investigations conducted by HHS’s Office of Inspector General resulted in 578 criminal actions against individuals or entities that engaged in crimes related to Medicare and Medicaid, and 781 civil actions, which include false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalties settlements, and administrative recoveries related to provider self-disclosure matters.

The Report highlights many of the major prosecutions starting on page 15 of the report. Many of them involved California companies.

The first ever kickback action against an EHR developer for receipt of remuneration from a pharmaceutical company involved Practice Fusion Inc., a health information technology developer based in San Francisco.

In 2020, it agreed to pay $145.0 million to resolve criminal and civil liability based on its solicitation and receipt of kickbacks from a major opioid company in exchange for implementing clinical decision support alerts in its EHR software that were designed to increase prescriptions for the drug company’s products, and agreed to pay over $26.0 million in criminal fines and forfeiture.