Medicaid. The Medicaid program provide health care coverage to millions of Americans, including some of the nation's most vulnerable populations, and is funded jointly by states and the federal government.

Mallinckrodt ARD LLC (previously Questcor Pharmaceuticals Inc.) paid $260 million to resolve separate allegations related to its drug H.P. Acthar Gel, which is approved to treat, among other things, acute exacerbations of multiple sclerosis and infantile spasms. The government alleged that the company knowingly underpaid rebates to the Medicaid program by improperly designating Acthar as a "new drug" as of 2013, as opposed to a preexisting drug for which Mallinckrodt had significantly raised the price in previous years.
Gold Coast Health Plan, a county-organized health system in California. and three of its providers paid a combined total of $70.7 million to resolve claims that they knowingly submitted or caused the submission of false claims to California's Medicaid program in connection with the "Adult Expansion" population that was created by the Patient Protection and Affordable Care Act.

Unnecessary services and substandard care. The department pursued and resolved matters in which providers billed federal health care programs for medically unnecessary services. This practice not only wastes taxpayer funds but also can expose patients to harmful procedures and treatments or cause them to forego other potentially more effective treatments.

American Health Foundation provided grossly substandard services that failed to meet required standards of care in various ways, including by failing to follow appropriate infection control protocols and not maintaining adequate staffing levels.
Providence Health & Services Washington, a health care and hospital system operating in seven western. states, paid $22.7 million to resolve allegations that it billed federal health care programs for medically unnecessary neurosurgeries.
Eargo Inc., which sells and dispenses hearing aid devices directly to customers nationwide, paid $34.37 million to resolve allegations that it submitted or caused to be submitted claims containing unsupported hearing loss-related diagnosis codes to the Federal Employees Health Benefits Program.

Medicare Advantage. The department pursued cases alleging that organizations participating in the Medicare Advantage program knowingly submitted or caused the submission of inaccurate information or knowingly failed to correct inaccurate information about the health status of beneficiaries enrolled in their plans to increase reimbursement. This past year, the department intervened in one case against Cigna and continued to litigate a number of other cases, including actions against UnitedHealth Group Independent Health Corp., Elevance Health (formerly Anthem) and the Kaiser Permanente consortium.

Instant Insights /

Health care fraud: DOJ recovered $1.7B in false claims cases in 2022

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