Healthcare fraud in the USA is nothing new, and the COVID-19 pandemic has only made things worse. The Trump and Biden administration introduced key changes to the healthcare sector to fight this major concern. Still, the ongoing pandemic and its deadly contagious variants have just led to a rapid surge of healthcare fraud in the nation. The topic is so serious that even political parties have kept aside their differences to unite together against the problem.
Ileana Hernandez of Manatt stresses the need for stringent monitoring and prosecution
Major government sweeps across the nation have uncovered frauds amounting to $900M and $1.38B (the biggest to date) in false billing claims. The alarming news here is a majority of the accused in these massive government sweeps are doctors, nurses, and other licensed healthcare professionals.
In context to the above, The US Government has launched innovative programs like the CARES act Provider Relief Fund that focuses on monitoring potential fraud cases in federal programs with the determination to recover lost funds due to false healthcare claims. The government in the nation has an aggressive determination to monitor and accelerate the prosecution of all the offenders in these fraudulent healthcare cases.
A legal expert speaks
Ileana Hernandez, the partner with Manatt, Phelps & Phillips Law Firm and a member of the firm’s healthcare litigation practice, says, “Accountability in healthcare fraud is one of the main trends in enforcement trends within the healthcare sector.”
Besides these government sweeps, as many as 500 lawsuits are linked to healthcare fraud in the USA. They have been filed in the courts of law on behalf of the federal government by private citizens. Several of them are based on-
- Double billing.
- Alleged off-label marketing.
- Stark violations.
- Lack of medical necessity claims.
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.”
As the country struggles to cope with the aftermath of the pandemic and the resurgence of infections due to new strains of the coronavirus, the US Department of Justice (DOJ) still pursues to eliminate the cases of healthcare fraud with an emphasis on medical device and drug companies, private practices, hospitals and in some areas, smaller groups of physicians and individuals.
Government Investigations and Prosecutions
The number of violations of the Anti-Kickback Statute and the Stark Law, along with government investigations, has increased drastically. In 2017, multiple high-profile lawsuits highlighted the severity of these legal violations. This has subsequently led to the government beefing up its actions to prosecute the offenders of these healthcare frauds in competent courts of law.
In 2018, the DOJ launched the Prescription Interdiction and Litigation (PIL) Task Force to examine local and state government lawsuits against manufacturers of opioids to determine any sort of assistance the federal law might provide in the above cases.
Ileana Hernandez of Manatt sums up by saying, the federal government recently has expanded emphasis beyond prescribers and healthcare providers that have submitted their claims to healthcare programs under the Federal Govt, for prescriptions for opioids. Their efforts include FCA investigations, administrative actions, and traditional criminal acts.