Healthcare fraud has been around for some years in the USA, and lawsuits in the field continue to rise rapidly. Despite changes in the healthcare sector introduced by the Trump and Biden administrations, the emergence of the COVID-19 Pandemic has aggravated the scenario. The number of legal and regulatory disputes has increased, thereby challenging these healthcare laws. Developments and new processes are not enough to deal with the nation’s surging and alarming incidents of healthcare fraud. Despite their divide, political parties have come forward to help the government deal with this serious condition across the country today.
Stringent monitoring of healthcare practices is the need of the hour, says Ileana Hernandez of Manatt
Ileana Hernandez, partner with Manatt, Phelps & Phillips Law Firm and a proactive member of the firm’s legal practice in healthcare fraud in the nation. She states new programs like the CARES act Provider Relief Fund introduced by the U.S. government place a high emphasis on monitoring potential fraud cases in Federal programs. They are highly committed to recovering the money lost on account of false claims due to fraudulent practices in the healthcare sector.
Ileana Hernandez of Manatt 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.” She also adds, “Many of these lawsuits were based on alleged off-label marketing, kickbacks, Stark violations, upcoding, double billing, and lack of medical necessity claims.”
Nationwide sweeps and astonishing revelations
The U.S. Department of Justice (DOJ) in June 2016 carried out a countrywide sweep across 36 districts where more than 300 individuals were charged with healthcare fraud cases. This incident reported the involvement of over 61 doctors, nurses, and other licensed healthcare professionals. More than $900M worth of false billing claims were uncovered during this sweep.
A year later, the government conducted another nationwide sweep that would go down in history as the biggest to date. This sweep was conducted across 41 districts, and over $1.3B worth of false billing claims were discovered. Healthcare fraud charges were filed against and involved over 115 doctors, nurses, and other licensed medical professionals.
One of the major factors in law enforcement trends is accountability within the healthcare industry. She states that many False Claim Act law settlements were imposed; this cost healthcare companies and its executives millions of U.S. dollars. This is where the industry shook up and took notice.
High-profile fraud cases have come to light
There has been a huge surge in the Anti-Kickback Statute and the Stark Law violations, along with other areas of government investigations. In 2017, many high-profile cases grabbed the severity of the above violations, with the government of the USA focusing on the prosecution of similar cases.
Ileana Hernandez of Manatt sums up by saying that with the threats of the Pandemic still looming; the healthcare industry should revamp its internal compliance programs as well as audit reviews to make sure the data obtained through them is legitimate and correct.