News & Insights


February 7, 2022

Health Headlines – February 7, 2022

DOJ Releases FY 2021 FCA Recoveries—On February 1, 2022, DOJ reported its second highest annual sum of False Claims Act (FCA) settlements and judgments, totaling more than $5.6 billion for FY 2021.  The vast majority of FCA settlements in 2021—more than $5 billion—concerned matters in the healthcare industry and included recoveries from “drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories and physicians.”  Some of the largest settlements in FY 2021 resulted from DOJ’s focus on the opioid epidemic.
In the press release, DOJ highlighted, among other things, FCA priorities concerning opioids, Medicare Part C, kickbacks, unnecessary medical services, and COVID-19 fraud. For example:

  • Opioids: DOJ brought allegations against providers who were known to promote and prescribe drugs for unsafe, ineffective, and medically unnecessary uses, as well as allegations of kickbacks. 

  • Medicare Part C: DOJ identified Medicare Part C as an important priority for investigation and litigation.  DOJ has focused on allegations involving plans and providers related to the manipulation of the risk adjustment process by submitting unsupported diagnoses.

  • Kickbacks: DOJ pursued allegations of improper payments and other alleged “schemes involving the willful solicitation or payment of illegal remuneration to induce the purchase of a good or service paid for by a federal health care program.”

  • Unnecessary Medical Services: Consistent with previous years, DOJ settled matters regarding allegations of providers billing federal programs for services that were medically unnecessary or for services not rendered as billed.

  • COVID-19: Enforcement efforts regarding pandemic relief monies focused on matters “involving improper payments under the Paycheck Protection Program.”  The DOJ will continue “to identify, monitor and investigate the misuse of critical pandemic relief monies.”

The government and qui tam relators filed 801 new cases in FY 2021. The full text of the DOJ Press Release is available here.
Reporter, Kasey Ashford, Washington D.C., +1 202 626 2906,

Also in the News

CMS Released the Part C and Part D Advance Notice; Comments are Due March 4, 2022
On February 2, 2022, CMS released the Advance Notice of Methodological Changes for calendar year 2023 for Medicare Advantage capitation rates and Part C and Part D payment policies (the Advance Notice).  CMS calculates the expected average change in revenue will be 7.98% as compared to CY 2022.  CMS will accept comments on the CY 2023 Advance Notice through Friday, March 4, 2022.  CMS will publish the final Rate Announcement by April 4, 2022.  The Advance Notice is here.  CMS has issued a Fact Sheet regarding the Advance Notice, which you can find here.