1. Using the readings, discuss the impact of Federal and State legal trends on our healthcare system. What is the impact of these same legal trends for you as a consumer of healthcare? https://attorne

A naly sis o f H ealt h C are F C A L it ig atio n T re n ds W edne sd ay, Ja nua ry 9 , 2 0 19 In 2 0 18 , t h e v o lu m e o f F a ls e C la im s A ct ( F C A) lit ig atio n r e m ain e d h ig h, a nd h e alt h c a re - re la te d qui t a m (i.e ., w his tle blo w er) c a se s c o ntin ue d t o le ad t h e w ay. U sin g d ata c o m pile d in t h e M in tz H ealt h C are Q ui T a m D ata base ( w hic h is d escrib ed fu rth e r b elo w ), t h is p ost ana ly ze s t h e t re nd s in c a se s u nse ale d in 2 0 18 . T o e va lu a te lo ng -te rm t re nd s, w e e xa m in e d th e annua l D epartm ent o f Ju stic e ( D O J) c o m pila tio n o f F C A c a se s . T o geth e r t h e se d ata s e ts sho w t h a t h e alt h c a re c a se s c o ntin ue t o m ake u p a la rg e m ajo rit y o f a ll w his tle blo w er ca se s b ro ug ht u nd er t h e F C A, a nd a lm ost t w o-th ir d s o f t h o se c a se s w ere b ro ug ht b y curre nt o r fo rm er e m plo ye es, m ostly a gain st la rg e p ha rm ace utic a l c o m panie s, p hysic ia ns, and h o sp it a ls .

R ece nt T re nds C aptu re d in t h e M in tz H ealt h C are Q ui T am D ata base s M in tz u se s it s H ealt h C are Q ui T a m D ata base t o t ra ck a ctiv it y in u nse ale d F C A c a se s t o se e w ha t t y p es o f c a se s a re b ein g b ro ug ht, w ho is b ein g t a rg ete d, a nd w ho is b rin g in g th o se c a se s. H ere a re s o m e h ig hlig hts fr o m t h e t w elv e m onth s e nd ed N ove m ber 3 0 , 2 0 18 .

W e a ls o r e port o n qui t a m c a se d eve lo pm ents p erio dic a lly t h ro ug h o ur Q ui T a m U pdate .

T re nd # 1: P harm ace utic a l C om pan ie s, P hysic ia n s, H osp it a ls , a n d H om e H ealt h C are C om pan ie s W ere t h e L e ad in g T arg ets o f U nse ale d C ase s in 2 018 The im porta nce o f d ru g t h e ra pie s in m odern h e alt h c a re is r e fle cte d in t h e h ig h v o lu m e o f FC A lit ig atio n a gain st p ha rm ace utic a l c o m panie s. A s s ho w n in T a ble 1 b elo w , pha rm ace utic a l a nd b io te ch c o m panie s w ere , b y a la rg e m arg in , t h e m ost c o m monly ta rg ete d d efe nd ant t y p e in F C A c a se s u nse ale d in 2 0 18 .

\[ p ag e\] Sourc e : M in tz Q ui T a m D ata base The c a se s u nse ale d a gain st d ru g c o m panie s in 2 0 18 t y p ic a lly fo cuse d o n a lle gedly im pro per m ark e tin g p ra ctic e s, s uch a s im pro per in d uce m ents o ffe re d o r g iv e n t o p re scrib ers , a s w ell a s o ff- la bel m ark e tin g o f p re scrip tio n d ru g s. T he v o lu m e o f p ha rm ace utic a l- re la te d lit ig atio n is p re sum ably a fu nctio n o f t h e la rg e v o lu m e o f d ru g r e im burs e m ents u nd er M edic a re a nd M edic a id , w hic h is a rg ua bly t h e c a se w it h re sp ect t o h o sp it a ls a nd p hysic ia ns a s w ell. T he g ro w in g im porta nce o f h o m e h e alt h a nd h o sp ic e c a re is r e fle cte d in t h e fa ct t h a t, fo r a se co nd y e ar in a r o w , t h a t s e cto r r a nke d fo urth in t e rm s o f t h e n um ber o f c a se s u nse ale d. G iv e n t h e o ng oin g g ro w th o f t h e e ld erly p opula tio n in t h e U nit e d S ta te s, s uch c a se s a re lik e ly t o c o ntin ue t o c o nstit u te a le adin g c a te gory fo r u nse ale d F C A c a se s.

T re nd # 2: G ove rn m ent In te rv e ntio n R ate s R em ain L o w Sin ce 2 0 12, w he n M in tz b egan t ra ckin g h e alt h c a re qui t a m lit ig atio n, g ove rn m ent in te rv e ntio n r a te s h a ve c o nsis te ntly r u n a t a bout 2 0 % . A s sho w n in T a ble 2 , t h a t t re nd c o ntin ue d in 2 0 18 .

\[ p ag e\] Sourc e : M in tz Q ui Ta m D ata base As t h is c ha rt s ho w s, t h e gove rn m ent o utrig ht declin e d 2 0 2 o ut o f 2 6 4 unse ale d c a se s, a declin a tio n r a te o f 7 7% .

The g ove rn m ent in te rv e ne d in w ho le o r in part in 4 5 o f t h e 2 6 4 ca se s, a n in te rv e ntio n ra te o f 1 7 % . ( T he bala nce o f t h e u nse ale d ca se s d id n o t d is clo se t h e gove rn m ent’s in te rv e ntio n decis io n). A cco rd in g t o th is d ata , t h e g ro w in g vo lu m e o f h e alt h c a re re la te d qui t a m lit ig atio n ha s n o t in cre ase d t h e gove rn m ent’s in te rv e ntio n ra te .

Tre nd # 3: C urre nt an d F orm er Em plo ye es a re M ost Com mon Whis tle blo w ers In c a se s u nse ale d in 2 0 18 , fo rm er e m plo ye es w ere ove rw he lm in g ly t h e m ost co m mon t y p e o f r e la to r, as s ho w in T a ble 3 b elo w , m akin g u p a lm ost h a lf o f a ll r e la to rs in t h e t w elv e m onth s e nd ed N ove m ber 3 0 , 2 0 18 .

Sourc e : M in tz Q ui T a m Data base To geth e r, c urre nt a nd fo rm er e m plo ye es m ade u p 63% o f a ll r e la to rs d urin g th a t p erio d, c o ntin uin g t h e tre nd t h a t in sid ers r e m ain th e m ost c o m mon s o urc e o f whis tle blo w er c a se s. T he num ber o f c o ntra cto rs a nd co nsult a nts b rin g in g qui ta m c a se s h a s g ro w n o ve r tim e, b ut t h o se c a te gorie s re m ain q uit e s m all in co m paris o n t o c urre nt a nd fo rm er e m plo ye es.

Lo ng-T erm T re nds Captu re d in D O J D ata Thre e y e ars a go we pub lis he d a p ie ce exa m in in g qui t a m lit ig atio n tre nd s b ase d o n Departm ent o f Ju stic e d ata .

Arm ed w it h d ata fo r t h e ensuin g y e ars , in clu d in g th e re ce ntly r e le ase d d ata fo r 2 0 18 , w e c o ntin ue t o exa m in e t re nd s in t h is sp ace . T he fo llo w in g a re so m e h ig hlig hts fr o m t h e most r e ce nt D O J d ata .

Tre nd # 4: Q ui T am Actio ns C ontin ue t o D om in ate F CA c a se s, E sp ecia lly in H ealt h C are In 2 0 15, o ur a na ly sis c o nfir m ed t h a t t h e g ro w th in F C A lit ig atio n o ve r t h e p re ce din g t w enty y e ars h a d p re dom in a ntly b een d ue t o c a se s b ro ug ht by p riv a te p artie s ( i.e ., w his tle blo w ers ) r a th e r t h a n t h e g ove rn m ent. T his t re nd h a s c o ntin ue d in t h e in te rv e nin g y e ars . T he c ha rts b elo w dem onstra te t h a t t h e t o ta l n um ber o f F C A c a se s is d riv e n la rg ely b y t h e n um ber o f qui t a m c a se s. F o r e xa m ple , a s T a ble 4 illu stra te s, t h e vo lu m e o f g ove rn m ent-in stit u te d c a se s h a s r e m ain e d la rg ely u ncha ng ed s in ce t h e la te 1 9 90s w hile t h e v o lu m e o f qui t a m c a se s h a s \[ p ag e\] skyro cke te d, le adin g t o o ve ra ll g ro w th in F C A lit ig atio n.

Sourc e : D O J F C A D ata fo r F Y20 18 Tha t s a m e t re nd is illu stra te d in b ar c ha rt fo rm in T a ble 5 , w hic h s ho w s t h a t a s t h e o ve ra ll n um ber o f c a se s c o ntin ue s t o c lim b, t h e g ro w th co nsis ts a lm ost e ntir e ly o f w his tle blo w er c a se s.

Sourc e : D O J F C A D ata fo r F Y20 18 The d ata a ls o illu stra te t h a t h e alt h c a re -re la te d c a se s ( c a te goriz e d b y t h e D O J a s “ H HS c a se s”) c o ntin ue t o d om in a te F C A c a se s. Ju st a s qui ta m lit ig atio n g ro w th h a s d riv e n in cre ase s in o ve ra ll F C A lit ig atio n, t h e d ata in T a ble 6 s ho w t h a t g ro w th in h e alt h c a re -re la te d c a se s h a s fu e le d t h a t t re nd .

\[ p ag e\] Sourc e : D O J F C A D ata fo r F Y20 18 And , a s w e fo und w it h F C A c a se s o ve ra ll, t h e v a st m ajo rit y o f H HS c a se s c o ntin ue t o b e b ro ug ht b y p riv a te in d iv id ua ls . A s s ho w n in T a ble 7 , ove r e ach o f t h e p ast t w enty y e ars , t h e p erc e nta ge o f h e alt h c a re -re la te d F C A c a se s in stit u te d a s p riv a te ly file d qui t a m c a se s h a s r a ng ed betw een s e ve nty -n in e a nd n in e ty -fiv e p erc e nt.

\[ p ag e\] Sourc e : D O J F C A D ata fo r F Y20 18 T re nd # 5: T ota l S ettle m ents a n d Ju dgm ents D eclin e, b ut H ealt h C are R eco ve rie s T re nd U pw ard Sin ce 2 0 14 , w e h a ve s e en a d eclin e in t h e t o ta l d olla rs r e co ve re d u nd er t h e F C A. A s s ho w n in T a ble 8 , t o ta l r e co ve rie s h a ve fa lle n fr o m a h ig h of $ 6.1 b illio n in 2 0 14 t o $ 2.8 b illio n in 2 0 18 , t h e s m alle st a nnua l r e co ve ry s in ce t h e $ 2.5 b illio n r e co ve re d in 2 0 09.

Sourc e : D O J F C A D ata fo r F Y20 18 \[ p ag e\] This d ro p in t o ta l r e co ve rie s a ppears t o b e d ue m ostly t o a 8 8% d ro p in t h e n um ber o f “ O th e r” F C A c a se s o ve r t h e la st t h re e y e ars ( i.e ., ca se s t h a t fa ll o uts id e o f t h e H HS a nd D oD c a te gorie s), a s illu stra te d in T a ble 9 .

Sourc e : D O J F C A D ata fo r F Y20 18 W hile h e alt h c a re -re la te d r e co ve rie s a ppear t o h a ve t ic ke d u p w ard in 2 0 18 , t h a t in cre ase m ay b e d ue , in p art, t o t h e g ove rn m ent’s c re ativ e acco untin g , in w hic h it in clu d ed in t h e F Y 2 0 18 fig ure s t w o la rg e s e ttle m ents a nno unce d o n O cto ber 1 , 2 0 18 , w hic h is t e chnic a lly in F Y 2 0 19 .

Ta ble 1 0 illu stra te s t h a t, w it h t h e e xce ptio n o f 2 0 06, t h e la st t w enty y e ars h a ve s e en qui t a m c a se s d riv e t h e r e co ve re d d olla rs .

Sourc e : D O J F C A D ata fo r F Y20 18 Giv e n t h e p re pond era nce of qui t a m la w suit s in o ve ra ll FC A lit ig atio n, t h is t re nd w ill pre sum ably c o ntin ue b eyo nd 20 18 .

©19 94-2 0 19 M in tz , L e vin , Cohn, F e rris , G lo vsky a nd Popeo, P .C . A ll R ig hts Rese rv e d.

Sourc e U RL:

http s:/ /w ww.n a tla w re vie w .c o m /a rtic le /h e alt h -c a re -e nfo rc e m ent-y e ar-re vie w -2 0 19 -o utlo ok-a na ly sis -h e alt h -c a re -fc a -lit ig atio n \[ p ag e\]