Opioids, healthcare fraud to remain top priorities under Biden DOJ

Healthcare providers can expect a continued high level of scrutiny when it comes to federal prosecutions of healthcare fraud, a U.S. Department of Justice official recently told a group of healthcare attorneys.

Michael Granston, deputy assistant attorney general for the DOJ’s commercial litigation branch, told the attendees of the American Health Law Association’s annual meeting in June that 2020 was a record year for healthcare fraud prosecutions.

Of the more than 900 new matters opened by the DOJ that year, 580 were health fraud matters. Most were prosecuted under the False Claims Act, which allows the federal government to prosecute fraud against the government and incentivizes whistleblowers to file claims.

Last year the department settled 265 healthcare-related False Claims Act claims, a record high.

Granston told the group to expect more of the same under the new Biden administration. He also shared that the DOJ plans to focus its prosecution efforts on contributions to the opioid epidemic, electronic health record misuse, manipulation of Medicare’s managed care program, senior citizen abuse, and COVID-19 relief fund fraud.

The result is continued exposure for healthcare organizations. According to the law firm Gibson Dunn, through the first half of 2021, False Claims Act settlements in the health care and life sciences industries totaled more than $228 million.

Med Law Advisory Partners collaborates with healthcare organizations in taking proactive measures to prevent such litigation, as well as measures in response to it.

For decades, Med Law’s consulting nurse experts have supplemented in-house legal and compliance teams in reviewing medical records for appropriateness of care and medical necessity, resulting in measurable, positive outcomes in investigative matters.

In the area of controlled substances, the Med Law team works with our clients to ensure they implement safe prescribing practices and help minimize the fallout in the event of a compliance investigation. Our consulting nurse experts have experience in providing audit support in investigations related to allegations such as reckless prescribing of narcotics and wrongful death related to overdose from prescribed controlled substances.

Taking a proactive posture will be crucial for healthcare organizations when it comes to the current environment. By evaluating policies and procedures, as well as ensuring effective training and compliance programs are in place, healthcare organizations can reduce their exposure to such claims.

Let our team of experts supplement yours. Contact us for more information on how Med Law can partner with your organization.