Moffitt Cancer Center to Pay $19.5 Million Settlement for False Claims Act Violations

Moffitt Cancer Center, a non-profit research hospital in Florida, has agreed to pay more than $19.5 million to resolve its civil liability under the False Claims Act for improper claims submitted to federal healthcare programs.

The improper claims were related to certain patient care items and services provided during research studies. The settlement is in relation to the self-disclosure of improper billing for clinical trial costs.

The Department of Justice announced that the hospital will pay $19,564,743 to settle the civil liabilities. This information is confirmed by the U.S. Department of Justice and the official press release from the Justice Department.

What is the False Claims Act

The False Claims Act (FCA), also known as the “Lincoln Law,” is a whistleblower law that allows private citizens to sue companies or individuals defrauding the government and recover damages and penalties.

The FCA is the federal government’s primary litigation tool in combating fraud against the government.

It includes a qui tam provision that allows people who are not affiliated with the government, called “relators,” to file actions on behalf of the government, which is informally called “whistleblowing”.

Role of the Department of Justice in Healthcare Fraud Cases

The Department of Justice (DOJ) plays a crucial role in healthcare fraud cases by investigating, prosecuting, and preventing fraud and abuse in healthcare benefit programs such as Medicare, Medicaid, and TRICARE.

The DOJ’s Health Care Fraud and Abuse Control Program is responsible for identifying and prosecuting the most egregious instances of health care fraud, preventing future fraud and abuse, and protecting program beneficiaries.

Some key aspects of the DOJ’s role in healthcare fraud cases include:

• Investigations: The DOJ conducts criminal and civil investigations of healthcare fraud cases, working closely with other federal, state, and local agencies, as well as healthcare fraud prevention partnerships and insurance groups.
• Prosecutions: The DOJ prosecutes defendants who orchestrate complex healthcare fraud schemes, resulting in significant financial penalties and, in some cases, criminal charges.
• Data Analytics: The Health Care Fraud Unit uses advanced data analytics and algorithmic methods to identify, investigate, and prosecute cases, leading to some of the largest healthcare fraud cases and initiatives.
• Multidistrict Initiatives: The DOJ collaborates with United States Attorneys’ Offices, the Criminal Division, and the Civil Divisions in particular the Fraud Section and Money Laundering and Asset Recovery Section (MLARS) of the Commercial Litigation Branch of the Civil Division to enhance healthcare fraud enforcement.
• Cooperation and Communication: The DOJ ensures cooperation and communication among components to enhance healthcare fraud enforcement, sharing information and expertise to improve the efficiency of investigations and prosecutions.

Overall, the DOJ plays a vital role in combating healthcare fraud, protecting the public fisc, and ensuring the integrity of healthcare benefit programs.

Recent Healthcare Fraud Cases

There have been several recent healthcare fraud cases reported in 2023. Some of the significant cases include:

• A nursing home testing fraud scheme that resulted in a $358 million settlement.
• A $172 million settlement from Cigna to settle healthcare fraud allegations.
• A $12 million healthcare fraud scheme involving two doctors in Dallas.
• A $60 million healthcare fraud and kickback scheme that resulted in charges against a man.
• A nationwide healthcare fraud enforcement action that resulted in criminal charges against telemedicine platform owners, laboratory owners, durable medical equipment (DME) providers, hospice operators, and pharmacists, among others, with losses exceeding $1.1 billion.

These cases involved various types of fraud, including kickbacks, falsified claims, and exploitation of vulnerable individuals.

The Department of Justice (DOJ) played a significant role in investigating and prosecuting these cases, working closely with other federal, state, and local agencies, as well as healthcare fraud prevention partnerships and insurance groups.

The DOJ’s Health Care Fraud and Abuse Control Program is responsible for identifying and prosecuting the most egregious instances of health care fraud, preventing future fraud and abuse, and protecting program beneficiaries.