As federal and state regulators crackdown on healthcare fraud, the need for experienced litigators has never been greater.
John LeBlanc of Manatt, Phelps & Phillips LLP, is one of those litigators. He spoke to Manatt’s Health Law Pulse publication about the trends he has observed in recent months.
“There are two things that have been going on,” LeBlanc said. “One is the continuing theme of the Department of Justice and the various U.S. attorney’s offices around the country to prosecute healthcare fraud; that is something that has been going on for a number of years, really not getting any better or any worse.”
But LeBlanc also noted an “uptick” in recent months for individual prosecutions instead of the significant healthcare fraud cases the DOJ has known for. “There’s also been a bit of an uptick in prosecutions for individuals who are involved in healthcare fraud-related schemes,” he said.
LeBlanc added that he thinks the individual prosecution strategy “goes hand-in-hand” with the DOJ’s push to audit physician practices and publicly report the results.
“I do think there are certain fundamental changes that are happening, not just in our industry, but throughout the healthcare industry,” LeBlanc said. “And it’s largely being driven by one overarching factor, which is cost.”
LeBlanc further stated that healthcare providers are being asked to do more with less, and the industry needs to explore different ways of delivering care if it wants cost savings. “I think as an industry, we need to put our heads together and come up with a way forward,” he said.
When asked if he believes the government’s enforcement actions will filter down to smaller providers, LeBlanc said, “I do think so. I don’t know that it has yet. You look at some of these settlements with large institutions, and there are significant fines.”
LeBlanc cited a settlement between St. Elizabeth Hospital Inc., which operates St. Elizabeth’s Medical Center in Boston, and the U.S. Attorney’s Office for the District of Massachusetts as an example. The hospital agreed to pay $10 million in restitution and forfeiture.
“This is a large fine enough to cause a significant rethinking of how a big institution deals with the government,” he said.
LeBlanc pointed out that one-way providers can avoid being targeted by enforcement actions is by complying with pay-for-performance programs, which have been implemented by most commercial insurers and the Centers for Medicare & Medicaid Services as part of the Affordable Care Act.
“I do think we’re going to see a continued focus on these types of programs by regulators,” he said. “To the extent providers take it seriously and ensure they implement systems that would put them in compliance with such programs, that can be a way to avoid scrutiny.”
LeBlanc concluded by saying, “I think we’re just seeing the beginning. I don’t know that it’s going to be a sea change or anything like that, but as an industry, we can expect more focus on this area.”
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