The current COVID-19 pandemic has led to a drastic increase in the number of criminal investigations surrounding the healthcare industry. It should be no surprise that we are seeing more providers, pharmacists, and medical professionals subjected to false claims act investigations. Though the number of instances remained low in recent years, we are seeing a steady increase of claims and recoveries throughout the country.
What is the False Claims Act?
The False Claims Act is a set of federal statutes surrounding people who knowingly submit claims to the government for the reimbursement of payment for various charges. In terms of healthcare, these claims can be made to Medicare, Medicaid, and Tricare regarding services that are not covered, services that are not rendered, and claims for services that are not required. Although there are numerous cases where medical professionals submit false claims with ill intentions, there are many who submit false claims in error. Not keeping adequate records can land medical providers in hot water and jeopardize their ability to practice and their freedom entirely.
Recent Trends in FCA Recoveries
The 2018 fiscal year showed a drastic dip in settlements and judgments involving the False Claims Act. Unfortunately for some, there has been a steady rise once again across the United States. The drastic dip in 2018 was met with an increase to over $3.05 billion in recoveries during 2019.
Reports issued by the Department of Justice show that whistleblower claims total over $271 million in payments under the department’s whistleblower remuneration programs. The DOJ was able to recover more than $2.2 billion in qui tam suits, far outstripping the 146 enforcement actions brought forth by the DOJ without the assistance of whistleblowers. Although the False Claims Act covers an array of business transaction types, healthcare-related recoveries remain in the lead.
The Rise in Healthcare False Claims Recoveries
Over the past two years, we have seen a dramatic increase in the number of false claims submitted by medical professionals across the United States. The healthcare industry leads in the total number of recoveries – coming in at more than $2.6 billion or 85% of all recoveries during 2019. These losses are in reference to those on the federal level and do not count recoveries surrounding state Medicaid programs where the DOJ provides assistance. The number of False Claims Act investigations continues to rise.
As more federal funding is made available to combat the COVID-19 pandemic sweeping across the nation, more providers are finding themselves in legal battles having to prove that the services they provide are justified. Although there are many bad actors who submit claims to obtain the money they are not rightfully entitled to, there are many provides who are falsely accused of filing false claims. Those who find themselves dealing with these circumstances should reach out to a criminal defense attorney as soon as possible.
Healthcare Fraud Group Can Help You
The team at Healthcare Fraud Group understands the significance of proving your innocence after being accused of engaging in home health care fraud. A conviction resulting from an investigation can result in fines, suspension of licenses, and a variety of other negative consequences. If you were accused of a crime or of similar forms of healthcare fraud, contact our defense attorneys at (888) 402-4054 to discuss your case as soon as possible.