Ileana Hernandez of Manatt, Phelps & Phillips talks about healthcare fraud in the future.
Q: What do you think is one of the most overlooked areas for fraud in healthcare/medicine?
A: I think one of the most overlooked issues is people who commit fraud in Medicare Part D because there are so many prescription drugs being dispensed. I think that’s an area that very few people are looking at.
Q: What is the next big issue, besides the opioid crisis, where healthcare fraud will possibly be happening?
A: Well, I think we’re going to see a lot in the area of hospital contracts and whether or not hospitals are overcharging patients. There is also the issue of patient dumping—when there is no community care available, and hospitals will either take patients in even if they don’t have insurance, or their only option is to put them on a gurney and wheel them out of the hospital onto the street or leave them at a bus stop. So that’s also going to be an area where we’re going to see more litigation.
Q: What is the future of healthcare fraud? How do you think it will change over time?
A: I think we’re going to see a rise in whistleblower cases. In 2016, the Department of Justice recovered more than $3 billion from whistleblowers—more than double all of the recoveries from health care fraud. I think that’s an indication that people are becoming aware, and they know there is a whistleblower reward out there for them if they will step up and do the right thing. In addition, I think we’re going to see an increase in self-reporting—companies taking a look at their contracts and seeing whether they are overcharging.
Q: What is your opinion on healthcare fraud? Has it changed since you became a partner with Manatt? If so, how so?
A: I still think it’s underreported because people aren’t aware enough to know what the issues are or how they can get involved. People should be mindful of their healthcare, but there are things out there, like whistleblowers, to help you expose fraud.
Q: Any predictions for the future?
A: I think the next big area will be medical devices, such as hip and knee replacements. We’re going to see those cases increase and the trend of whistleblowers coming forward with those things.
Q: Any advice for people who are committing fraud in healthcare?
A: I would tell them to stop, step back and take a look at what they’re doing. Usually, people don’t mean to do anything wrong; it is business as usual for them, and no one thinks of the consequences. But, on the other hand, people should know there are consequences, and prosecutors are looking to make examples out of people.
Q: What more can be done to combat healthcare fraud?
A: The government has been making great strides in the last couple of years; I think we’ve seen this with the Affordable Care Act, and it is just going to continue. People should know they have the right to report information if they see something that doesn’t seem right. The government has significant resources to help people step forward—they should take advantage of it.
Q: What are the typical types of fraud in healthcare?
A: It can be billing, claims, drugs, medical devices…anything related to health care. I think that is what makes it so difficult because there are so many elements out there, and it is so easy to get caught up in the day-to-day operations and forget about what they’re doing. I think that’s why we see so many people getting caught up in this—it was just part of their job, and they didn’t know about it.