Prosecuting Healthcare Fraud is a serious issue that affects all of us. One person who has been deeply affected by this issue is Ileana Hernandez of Manatt Phelps & Phillips Law Firm and a member of the firm’s healthcare litigation practice group.
Hernandez has experience across many different areas of the industry, including pharmaceuticals and medical devices and reimbursement issues like Stark Law and Anti-Kickback violations. In addition, Hernandez is currently advising on several larger-scale False Claims Act (FCA) matters that involve significant damages stemming from alleged healthcare fraud.
“Prosecutions are on the rise, and we’re seeing the Department of Justice (DOJ) and HHS get more aggressive in their enforcement efforts,” says Hernandez. “This means that companies need to be aware of any potential compliance violations, whether they’re intentional or inadvertent.”
Hernandez also points out that healthcare fraud is a serious issue because taxpayers are footing part of the bill. “We forget that our tax dollars are paying for this. We need to realize that there is a cost associated with healthcare fraud, and taxpayers ultimately pay it.”
Hernandez adds that the increase in enforcement activity could also mean an increase in whistleblower lawsuits filed under seal so as not to tip off defendants who may try to cover up their misconduct before getting caught.
“We’ve seen a huge increase in qui tam lawsuits being filed under seal,” she explains. “In fact, we have over 50 cases currently pending that are all under seal.”
Hernandez explained that this means there could be many cases out there that people aren’t aware of, even if they have been filed under seal. “It’s vital for companies to know what is going on with these qui tam lawsuits,” says Hernandez.
“Companies need to understand the risk associated with their business practices and ensure they are compliant to avoid liability.”
When asked what companies should be doing to avoid liability, Hernandez responded by saying that companies must have a robust compliance program. “A lot of times when I see potential healthcare fraud issues at the company level, there are also compliance violations,” says Hernandez.
“It’s important for businesses to understand what constitutes an actual violation because you can’t just have a compliance program in place. If you have a good compliance program that’s just on the shelf, then it won’t do any good.”
Hernandez recommends that companies do the following to avoid issues with healthcare fraud:
– Have systems in place for compliance and reporting, including internal audits.
– Conduct regular training programs so employees know their responsibilities under anti-kickback statutes, Stark Law, and other areas relevant to your company’s business model.
– Address any compliance issues as soon as they come to light. “The longer a company waits to address any compliance concerns, the more difficult it will be for them,” says Hernandez.
– Keep thorough records that reflect what your business does and how you do it so if there are ever questions about compliance or reimbursement activities, you have the documentation to prove that you are compliant.
– Ensure that all employees understand the compliance requirements of the healthcare industry and how to protect your company from fraud.