Healthcare fraud is intensely on the rise in the USA, and the Government and political parties have joined hands to combat this mounting problem with reinforced vigor. Changes have been made to the US healthcare sector by US Presidents Trump and Biden, respectively; however, with these new processes and developments, the problem still prevails. The advent of the Pandemic saw a huge increase in regulatory violations and legal disputes in the nation due to new infections caused by the surfacing of mutant strains of the coronavirus in the nation.
Ileana Hernandez of Manatt gives an insight into massive false billing claims worth millions
Ileana Hernandez, a 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 US government has the determination to prosecute people actively involved in healthcare fraud. There have been massive nationwide sweeps conducted by the Department of Justice or the DOJ in the USA. They were conducted across 36 and 41 districts in 2016 and 2017, respectively. In the first sweep, more than 300 healthcare professionals were charged with false billing claims worth $900M: the guilty included doctors, nurses, and other licensed healthcare professionals.
In the second nationwide sweep conducted in 2017, more than 115 professionals, including doctors, nurses, and licensed medical practitioners, were charged with false billing claims. However, the amount of healthcare fraud here was $1.3B, the biggest in US history to date.
Ileana Hernandez of Manatt says, “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.”
Recovering lost money due to false billing claims
New healthcare programs in the nation have been launched to battle this problem, for instance, with 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 to recover lost money due to false billing claims. Measures have been taken to weed out healthcare fraud from the system aggressively. There is a focus on companies dealing with medical drugs and devices, small groups of individuals and physicians (in some areas), and other professionals linked to the healthcare sector.
She says in the past year, the Federal Government in the USA has stepped up actions to focus beyond manufacturers to target healthcare providers who have submitted false billing claims for opioid prescriptions under its healthcare system programs. These actions include FCA investigations, administrative acts, and traditional criminal actions as well.
Ileana Hernandez of Manatt sums up by saying, “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.”