The USA is plagued with rising cases of healthcare fraud today. Though the Trump and Biden administrations have introduced reforms in the healthcare sector to arrest these cases, these new processes and developments are insufficient to combat the problem. Political parties have even stepped forward after casting their differences aside to help the Government fight the problem. Legal disputes and violations of regulations have increased after the coronavirus pandemic. The government has pledged to fight the problem and prosecute offenders guilty of healthcare fraud in the land.
Ileana Hernandez of Manatt on the steps taken by the US government to arrest theproblem
Ileana Hernandez is a partner with Manatt, Phelps & Phillips Law Firm, and an esteemed member of the firm’s healthcare litigation practice in the USA. She says, “Accountability in healthcare fraud is one of the main trends in enforcement trends within the healthcare sector.”
In the previous year, the Federal Government of the USA has widened its concentration beyond manufacturers to target prescribers and other healthcare providers who had submitted claims to the Federal healthcare programs for opioid prescriptions. FCA investigations, administration actions, and traditional criminal acts came under the government’s purview of the above focus to eliminate the instances of healthcare fraud in the nation.
Ileana Hernandez of Manatt adds in February 2018, the Department of Justice announced the Prescription Interdiction and Litigation (PIL) Task Force in the land. Its main objective was to examine state and local government lawsuits against opioid manufacturers to determine any assistance the Federal Law could provide to them.
The COVID-19 Pandemic has led to a rise in fraudulent healthcare activities
She adds the advent of the Pandemic heightened legal disputes and cases. The healthcare sector in the country should implement significant compliance programs internally with audit reviews to ensure the data is legitimate and accurate.
Healthcare plan compliance efforts vary extensively, and she says, “Given the increased interest in the healthcare industry, health providers and staff should carefully review their processes for risk adjustment, data collection, and validation.”
Nationwide sweeps reveal shocking details
The Department of Justice or DOJ in the USA have executed nationwide sweeps across districts and uncovered healthcare fraud amounting to $900M and $1.3B (the biggest in US history to date) in the form of false billing charges. Members of the healthcare fraternity-like doctors, nurses, and other licensed healthcare professionals, were charged with false billing. The story does not end here. There have been nearly 500 lawsuits linked to healthcare fraud filed by private citizens on behalf of the federal government. She adds, “Many of these lawsuits were based on alleged off-label marketing, kickbacks, Stark violations, upcoding, double billing, and 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.”