False claims settlements in health care total $1.7B in 2024

The DOJ once again said fraud enforcement in Medicare Advantage is of “critical importance.” Concerns about MA fraud have grown in recent years as the program has increased in popularity. 

The FCA seeks to hold companies and individuals accountable for knowingly and falsely claiming money or knowingly failing to pay funds owed to the U.S. government. For the past several years, the majority of federal FCA enforcement has centered on health care, as regulators have attempted to crack down on fraud.  

In a news release, the DOJ said many of its investigations last year targeted providers that billed federal health care programs for medically unnecessary services and substandard care or engaged in referral kickback schemes. 

The Department of Justice recorded over $2.9 billion in settlements and judgments under the False Claims Act in 2024, with the majority of settlements coming from health care. 

Health care settlements totaled $1.67 billion. The money will go toward restoring defrauded federal health care programs, including Medicare, Medicaid and the military health program Tricare, according to the release. 

The agency sought settlements against providers, pharmaceutical companies and pharmacies that allegedly leveraged the opioid epidemic to defraud the government. 

Regulators have also sought to tamp down on health care fraud in MA plans as the coverage option has grown increasingly popular.