Insights By Ileana Hernandez of Manatt on Why the USA is Plagued by Healthcare Fraud and The Rising Need for ProsecutionAugust 27, 2021
The healthcare sector in the USA is inundated with fraudulent practices calling for the need for faster prosecution. Former US President Trump rolled out some changes that President Biden later reversed. Legal disputes are on the rise, and the COVID-19 Pandemic has also accelerated them, with fresh infections being reported across the nation due to the emergence of new contagious coronavirus variants.
Ileana Hernandez of Manatt reveals some real-life facts
The Department of Justice conducted an extensive sweep across the country of 36 districts in 2016. The shocking revelations that surfaced were a significant number of healthcare fraud charges were registered against more than 300 professionals from the industry. They included 61 doctors, other licensed medical practitioners, and doctors. The sweep uncovered over $900M in false billing claims. The government is determined to prosecute all the offenders engaged in fraudulent healthcare practices and activities.
One year later, which is the biggest healthcare fraud to date, another extensive sweep across 41 districts in the USA uncovered over $1.38B in false billing claims that resulted in registering charges of fraud against over 115 doctors, other licensed medical professionals and nurses.
Private individual lawsuits
“In addition to the large government sweeps, nearly 500 lawsuits related to healthcare fraud were filed by private citizens on behalf of the federal government,” said Ileana Hernandez of Manatt. “Many of these lawsuits were based on alleged off-label marketing, kickbacks, Stark violations, upcoding, double billing and lack of medical necessity claims.”
A desperate bid to recover lost money
New programs in the nation have been launched, for instance, the CARES act Provider Relief Fund. The government of the USA is now placing a high priority on monitoring cases of potential healthcare fraud in federal programs with the objective to recover the money lost due to false claims. Ileana Hernandez,the partner with Manatt, Phelps & Phillips Law Firm and a proactive member of the firm’s healthcare litigation practice, says, “Recent activities demonstrate the government’s fierce determination to monitor and prosecute healthcare fraud cases.”
The need to purge fraud out from the healthcare sector
As the county continues to battle the Pandemic with the resurgence of infections across the nation, the DOJ constantly is boosting its efforts to purge cases of healthcare fraud with an emphasis on hospitals, private practices, companies dealing with medical devices and drugs, and in some places, small groups of physicians and individuals associated with the healthcare sector.
In short, she says, “In the current healthcare climate, nobody is immune to the government’s efforts to stomp out cases of healthcare fraud and abuse, and they will go to any length to recoup monies and prosecute entities.”
Ileana Hernandez of Manatt sums up by saying in the past year, the federal government in the USA has boosted its efforts and focus beyond manufacturers to target healthcare providers who have submitted claims for opioid prescriptions under its healthcare programs. Their efforts also include FCA investigations, traditional criminal actions, and administrative acts. She says, “Health plan compliance efforts vary widely,” “Given the increased interest in the healthcare industry, health providers and staff should carefully review their processes for risk adjustment, data collection, and validation.”