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TX case highlights DOJ’s $3B in health care fraud winnings

Yes, billions. The Department of Justice (DOJ) continues its crackdown on health care fraud violations in part because it results in large payouts. In 2019, the federal agency reports it recovered over $3 billion from settlements and judgements for False Claims Act violations.

Lawmakers passed this law to hold those accountable who receive payment from government programs based on false pretenses. The agency claims it has recouped an estimated $62 billion since Congress strengthened the False Claims Act in 1986.

A closer look at 2019: What were the violations that led to high government payouts?

The DOJ states the vast majority of funds recouped were connected to health care fraud crimes. More specifically: $2.6 billion. And the cases were diverse. They included everyone from drug manufacturers and hospitals to individual health care providers like nurses and physicians.

The DOJ used a recent case out of Texas to highlight the success of their efforts. The case of Dr. Jorge Zamora-Quezada involved allegations the physician falsely diagnosed patients with rheumatoid arthritis. The government then accused the doctor of filing claims to cover unnecessary medical intervention and treatment for these patients. The government was able to gather enough evidence to support the claims and the court found the health care professional guilty for partaking in a $325 million-dollar health care fraud scheme.

A look into 2020: What do these findings mean for the coming year?

The case outlined above was just one of many examples of the cases the government chose to investigate in 2019. The agency will likely continue to investigate a wide mix of cases, but has stated it is committed to “holding drug companies accountable for their role in the opioid crisis.” As such, it is likely we will continue to see an increase in cases involving medically unnecessary use of opioids.