Ileana Hernandez of Manatt Gives Insights on The Increasing Healthcare Frauds in The USA and the Need to Focus on Prosecution

Ileana Hernandez of Manatt Gives Insights on The Increasing Healthcare Frauds in The USA and the Need to Focus on Prosecution

Healthcare frauds in the USA are rapidly increasing despite changes made to the sector by the Trump and Biden administration in recent years. The COVID -19 Pandemic has accelerated the number of lawsuits pertaining to fraudulent healthcare activities due to the rising number of infections caused by the new variants of the coronavirus in the nation. Legal disputes and regulations have increased, but they are not enough to battle this major problem plaguing the nation right now.

Ileana Hernandez of Manatt reveals the surge of healthcare fraud by members of the medical fraternity

Ileana Hernandez, a partner with Manatt, Phelps & Phillips Law Firm and a member of the firm’s healthcare litigation practice in the country, states the recent activities depict the fierce determination of the USA government to aggressive fight and prosecute offenders associated with healthcare fraud cases in the nation.

In two major nationwide sweeps against healthcare fraud conducted by the Government of the USA, she reveals that frauds amounting to $900M and $1.3B in false billing claims (this being the biggest in the nation to date) were discovered. An alarming cause of concern is members belonging to the healthcare fraternity-like doctors, nurses, and other licensed healthcare professionals, were directly involved.

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”.

She goes on to say, “Many of these lawsuits were based on alleged off-label marketing, kickbacks, Stark violations, upcoding, double billing, and lack of medical necessity claims.”

Medical cost concept

Grappling with the woes of the pandemic

As the country still fights the pandemic with new cases emerging across the nation, the U.S Department of Justice continues its efforts to free the healthcare industry from fraudulent activities focusing on drug and medical device companies, hospitals, and private practices. Besides them, in some areas, the DOJ is also targeting smaller groups of physicians and individuals.

In the present healthcare scenario, no one is immune to the efforts of the government to weed out cases of healthcare abuse and fraud. They will go the extra mile to recover lost money and prosecuting the offenders.

An Overview of The False Claims Act

The increase in the cases of fraudulent healthcare practices has resulted in significant changes in the enforcement trends. These shifts started to take place much before the COVID-19 pandemic took over the world. However, since the outbreak of the pandemic, the instances of healthcare frauds have surged immensely.

In 2015, the Deputy Attorney General, Sally Yates, introduced the “Individuality Accountability for Corporate Wrongdoing” memo that directed all attorneys in the USA to target those involved in corporate crimes fiercely. This also included individuals belonging to 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 adds, “When several False Claim Act settlements were imposed, costing healthcare companies and executives millions of dollars, the industry took notice.” These cases are becoming common, and they are aggressively being investigated by the Federal Government in the USA today.


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