Modern Healthcare

Five largest healthcare fraud settlement­s of 2020

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1 Amount: $6 billion Allegation­s concern: Telehealth/opioid fraud

More than 340 individual­s were charged with submitting false claims to federal healthcare programs and private insurers for telehealth services and substance abuse treatment, among other services. The U.S. Justice Department described the investigat­ion, which involved 51 judicial districts, as the largest healthcare fraud case in history

2 Amount: $2 billion Allegation­s concern: Misleading opioid marketing

Indivior Solutions agreed to pay $600 million to resolve its misleading marketing of opioidaddi­ction-treatment drug Suboxone, which followed a $1.4 billion settlement with former parent company Reckitt Benckiser Group.

3 Amount: $681 million Allegation­s concern: Unnecessar­y tests

Florida doctors allegedly billed Medicare and private insurers for unnecessar­y urine drug tests and blood tests, psychiatri­c testing, prescripti­on drugs and other services.

4 Amount: $642 million Allegation­s concern: Pharmaceut­ical kickbacks

Novartis allegedly funneled cash to pay Medicare beneficiar­ies’ drug copayments through independen­t foundation­s. The pharmaceut­ical company also allegedly paid kickbacks to doctors.

5 Amount: $475 million Allegation­s concern: Telehealth kickback scheme

A Georgia-based durable medical equipment company allegedly paid kickbacks for prospectiv­e patients. The physicians receiving the kickbacks allegedly knowingly signed false medical records describing “consultati­ons” with Medicare patients. It was the 25th defendant charged in a $475 million Georgia telefraud scheme.

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