John LeBlanc of Manatt has some important news for people in the healthcare industry.
Says LeBlanc, “Healthcare reform is just starting to impact businesses.” He adds that with increasing regulations comes an increasing need for vigilance about providing proper documentation of services delivered. However, the new rules are just one aspect of this complex issue.
Explains LeBlanc, “Healthcare fraud has been around for a long time. It’s not new to Medicare or Medicaid.” He points out that Medicare and Medicaid are two of the largest sources of funding for healthcare practices. He adds that health care budgets are enormous and provide an opportunity for non-reimbursed services to be covered and billed for under the table.
When asked about whether fraud is increasing in scope, LeBlanc explains that it is difficult to generalize. He says that fraud continues to be a problem in many areas of American life, and healthcare is just one of them. Claims can come from anywhere, including patients and doctors themselves. Fraudulent schemes continue to be uncovered involving billing for services never rendered or double billing. More complex schemes could include doctors padding bills by doing more than was necessary to receive the maximum payment or administering treatment in a different state to receive higher reimbursement.
Says LeBlanc, “Healthcare fraud is not limited to any particular area of the country.” Instead, fraud can occur anywhere, and the types of schemes uncovered continue to become more complex. For example, billing Medicare and Medicaid for services never rendered is known as ‘Upcoding.’ This can result in a $10,000 fine per incident.
Claims LeBlanc, “It’s difficult to generalize about how healthcare fraud impacts American society.” The impact on healthcare dollars is one of the most obvious ways in which it impacts society. However, LeBlanc points out that healthcare fraud also affects people who are not involved with healthcare. Explains LeBlanc, “It results in increased costs for everyone.” He adds that insurance premiums will increase for everyone nationwide if insurers must pay more money to cover fraudulent schemes.
Says LeBlanc, “Healthcare fraud is a top government priority.” He believes that the Biden Administration has developed some very effective methods of ferreting out schemes that will benefit all areas of American life. Because universal healthcare coverage is being discussed in the public domain, fraudulent activities are under more scrutiny than ever before.
The government has created a new agency that is much more effective in prosecuting healthcare fraud. Explains LeBlanc, “Health Care Fraud Prevention and Enforcement Action Team – or HEAT team for short.” He adds that this special task force is devoting the largest amount of resources to combating healthcare fraud than any other country globally. As a result, LeBlanc believes the situation is in the process of getting much better.
LeBlanc predicts that we will reach a tipping point where healthcare fraud becomes less and less common at some point. In addition, he believes that the push for universal health care coverage will increase this effect to make providers more accountable to their patients and payers.