As the pandemic rages on, more and more people are becoming sick. In addition, with many people out of work, there has been a significant increase in healthcare fraud. John LeBlanc of Manatt talks about this issue and some other effects the pandemic is having on healthcare law.
“There’s a huge number of people that are out of work and unable to go into the doctor’s office. The result of that is a lot of people who would normally get medical treatment are going to go without,” said LeBlanc.
LeBlanc continued, “Also, the fact that you have a significant number of people out of work has caused a commensurate increase in fraud and scams where doctors and other healthcare providers are taking advantage of people.”
“Another area of healthcare fraud that we’ve seen a significant increase in is billing for services not rendered. This includes billing for unnecessary tests, surgeries, treatments, and consultations,” said LeBlanc.
“In addition to an increase in billing for services not rendered, we’re also seeing an area of healthcare fraud which occurs when someone bills the wrong insurer or receives reimbursement from the wrong insurer for the same service,” said LeBlanc.
“Another area of healthcare fraud that we’ve seen is so-called ‘present on admission’ fraud. This occurs when someone goes to a hospital, has an illness or injury diagnosed. Then they leave without being treated, which allows the insurer to get reimbursed twice – once for the diagnosis and once for the treatment,” said LeBlanc.
“We also continue to see significant healthcare fraud in prescription drug abuse. People are faking symptoms, selling medication, or doctor shopping to obtain multiple prescriptions of highly addictive drugs like oxycodone (oxycontin),” said LeBlanc.
On top of all this, John says that employment of nurses is lagging. He said, “We also see shortages in the nursing field exacerbated by the pandemic.”
“Many of our healthcare providers are having to work more hours at their regular jobs. Some of them are working long days back-to-back with little to no time for rest or recuperation.”
“Many of our healthcare providers and facilities are having difficulty staffing their departments because of these long hours and shortages.”
“The combination of all this results in a decline in the quality of care that we’re receiving,” said LeBlanc.
One other area that is seeing a significant increase in healthcare fraud is the lawsuits that are being filed. “There’s an incredible number of medical malpractice suits that are being filed right now where people are claiming they’re injured by the pandemic virus or some other biological agent.”
“At least one attorney general has said these claims would be considered healthcare fraud if they were made in connection with Medicaid or Medicare claims,” said LeBlanc.
To address the concerns about healthcare fraud, John says that investigations are being stepped up. He said, “Of course, both the states and the federal government have stepped up their efforts to investigate and prosecute healthcare fraud.”
“Significantly more resources are being dedicated to rooting it out.”