Recent Trends in Healthcare Fraud False Claims Act Cases

Below Qui Tam attorney Tony Munter discusses The Affordable Care Act and how it has impacted Qui Tam healthcare fraud cases. To learn more contact a False Claims Act attorney.

How Has Healthcare Fraud Changed Under Obamacare (the Affordable Care Act)?

Well, interestingly enough, Obamacare included a couple of amendments to the Fraud Claims Act which were actually pretty helpful to the False Claims Act and strengthened it. Beyond that, it hasn’t changed much except that people are more aware of the cost of healthcare and how healthcare costs are such a big part of the government’s budget.

There have been some things done in certain agencies to investigate more healthcare fraud. I’m not sure that’s directly related to Obamacare however. I do think that the public is much more aware of the cost involved in healthcare and how we all ultimately end up paying for it and therefore, people are a little bit more attentive I think now to the potential healthcare fraud for costing all of us a lot of money.

Are Whistleblower Cases Within the Healthcare Industry More Frequent?

I think so because people who get into healthcare get into it for the right reason. Most people who go to become a nurse or a doctor  get into it because they want to make a living but also to treat and care for patients.

As opposed to some other industries you could think of maybe, they are more easily offended when that isn’t the priority at a service provider or at a hospital of what have you. They are easily annoyed when they see something going on that’s wrong, especially if it endangers patients. It takes certain amount of personal fortitude to decide that what is happening is wrong, and then decide that you’re going to stand up, and fight it to be a whistleblower. I think that’s why there are healthcare whistleblowers because they understand what’s at stake and they care.

How is Healthcare Fraud Different From Medical Malpractice?

Medical malpractice is usually an individual event or a relatively isolated event. The purpose of medical malpractice isn’t particularly to rip off the government. It’s a medical professional making a terrible decision that can cause harm to a patient.  It’s not based on the idea of how do we get money out of the government or how do we bill for stuff that we’re not entitled to.

What Makes Healthcare Fraud Cases Challenging?

Well, I think there’s several things that make healthcare fraud challenging. You have to learn about part of an entire industry. If it involves medical devices, then you have to learn about the regulations involved in medical devices and about the particular medical device that’s  involved.

Then, you have to apply that and learn about the regulations that govern the marketing of it and then you have to apply that to the False Claims Act.  So there can be a myriad of things to learn before you can figure out what it is that the company or the service provider did that was wrong. It can be highly technical and involve learning a lot about a new sub industry. That can make it challenging and very interesting.


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