Healthcare fraud has grown exponentially in the USA, much before the advent of the Affordable Care Act (ACA) or the COVID-19 Pandemic. Health fraud is nothing new in the nation as it has been around for a very long time now. Generally, it has been seen that any sort of fraud surges with technological advancements. This means there is an urgent need to beef up internal controls for assessments and risk management to keep up with this surge. As vaccination drives are rigorously conducted across the nation, both the state and federal law enforcement agencies are persistently investigating and prosecuting the offenders associated with COVID-19 linked healthcare fraud.
John LeBlanc Of Manatt Speaks On The Rise Of Covid-19 Related Healthcare Fraud
John M. LeBlanc is a partner with national healthcare litigation firm Manatt, Phelps & Philips. He states in the healthcare sector, the efforts of the law enforcement agencies have increased. They are targeting fraudsters responsible for misappropriating funds from the Provider Relief Fund (PRF). Cases are surging, and people are taking advantage of the system at every single opportunity, including vaccination cards and medical supplies that have been counterfeited.
Many Flaws In The Security System
John LeBlanc of Manatt goes on to add that the coronavirus pandemic highlighted several security loopholes in the healthcare systems serving people. He says, “Healthcare fraud was the most significant source of illicit funds in the nation with over $100B in proceeds and accounted for more than 35 percent of all illegal proceeds laundered in the United States.”
Corporate Fraud Tops The List
It is not surprising that corporate fraud carried out by healthcare providers accounts for the biggest percentage of COVID-19 related cheating. This is because fraud schemes can mimic legal transactions with complicit doctors and other healthcare professionals that can bypass or manipulate internal controls. Detection becomes a challenge, especially when the source of the fraud is within the systems, and the presence of the pandemic makes the problem more exasperating.
A Grave Threat To The Public
Every healthcare provider getting paid from the Provider Relief Fund is obligated to certify the appropriate use of these funds and prove that they were used for these purposes only. Besides the above, they should attest to the payment terms and conditions and reference all the relevant regulations and statutes.
Besides fraud linked with government relief programs like PRF, instances of counterfeit claims have increased as well in the nation. These include fraudulent vaccines, a surge in fake vaccination records, and medical claims, all of which are a severe threat to the public in the post-pandemic era.
John LeBlanc of Manatt says there are at present over 4.5 million claims per day under Medicare. The increased government focus lies on those who have received funds from the Provider Relief Fund created as a vital component of the more expansive Coronavirus Aid, Relief, and Economic Security Act.