The surge of healthcare fraud in the USA is alarming despite changes to the sector introduced by the Trump and Biden governments. Major shifts in the law enforcement trends are simultaneously taking place. The COVID-19 Pandemic has made the situation more challenging, with fresh infections taking place because of the mutated variants of the coronavirus. Political parties have set their differences aside and joined hands with the federal government to fight this surge in healthcare fraud in the nation.
Ileana Hernandez of Manatt explains The False Claims Act in the nation
Ileana Hernandez, a partner with Manatt, Phelps & Phillips Law Firm and a member of the firm’s healthcare litigation practice in the nation, says, “Recent activities demonstrate the government’s fierce determination to monitor and prosecute healthcare fraud cases.”
The surge in cases accompanies significant shifts in law enforcement trends to combat this issue. These shifts began before the Pandemic emerged, and cases have risen since its outbreak across the globe. In 2015, the United States Deputy Attorney General Sally Yates released the Individuality Accountability for Corporate Wrongdoing” memo with directions to every attorney in the USA to aggressively target individuals engaged in corporate crimes, including those in the healthcare sector.
Ileana Hernandez of Manatt says, “Accountability in healthcare fraud is one of the main trends in enforcement trends within the healthcare sector,” and she adds, “When several False Claim Act settlements were imposed, costing healthcare companies and executives millions of dollars, the industry took notice.”
Violations of the Anti-Kickback Statute and The Stark Law
There has been a rise in the violations of the Anti-Kickback Statute and The Stark Law. High-profile cases in 2017 highlighted the severity of these violations with the focus of the government to prosecute these types of lawsuits.
These cases are increasing commonly and are being aggressively investigated by the Federal government authorities. She cites the example of the owners of an acute care hospital located in Los Angeles who paid $42M for the settlement of FCA violations. Allegations surfaced; they offered kickbacks to referring doctors. In Missouri, healthcare professionals had to pay $34M for settling violations associated with the submission of false claims to Medicare for services entailing chemotherapy.
Other prosecution and investigation trends of the USA government includes lawsuits pertaining to:
- Alleged medical necessity.
- Managed care environments.
- Fighting the Opioid epidemic in the nation (this has attracted a lot of attention from both the media and the federal government in the USA.)
Ileana Hernandez of Manatt says, “Pharmaceutical manufacturing companies and wholesale distributors have recently seen the most activity, with lawsuits filed by nearly every state, including several Native American tribal nations,” and adds that “All are seeking to recover funds that they have expended to deal with opioid abuse.”
She sums up by stating in the past year; the federal government has broadened its concentration beyond manufacturers to target healthcare professionals and prescribers who have submitted claims to healthcare programs under the Federal government for opioid prescriptions. These efforts cover FCA investigations, administration actions besides traditional criminal acts in the USA.