There is almost no area of life that has not been affected by the pandemic of Covid-19 outbreak and white-collar crimes and its enforcement is no exception. A number of unscrupulous individuals and organizations tried to leverage this crisis for their benefit and carried out a host of fraudulent activities. Ken Julian mentions that the Covid-19 pandemic especially underlined many weaknesses in the healthcare system, including the large scope for frauds and nefarious processes. Ken is a partner of the healthcare litigation practice at Manatt, Phelps & Phillips, which makes him an ideal candidate to talk about frauds associated with the medical domain.
Healthcare frauds are unfortunately not a new thing. However, the global pandemic managed to highlight the grave importance of identifying and reporting healthcare fraud. The life-and-death consequences of healthcare fraud were seen to manifest in several ways, including lack of funds to buy respirators, unnecessary medical procedures being performed, or ineffective drugs being prescribed. Ken Julian points out that healthcare fraud just not simply incur losses for one person. It in fact can have a negative impact on the lives of a large number of people. The diversion of funds taking place due to healthcare frauds leads to an increase of expenses associated with a wide range of actual medical services and care solutions that patients might be in dire need of. Frauds often lead to the reduction of coverage benefits, force higher premiums for individuals and their employers, as well as re-defines eligibility for programs like Medicaid, either directly or indirectly.
Covid-19 pandemic was among the biggest healthcare crisis the world had witnessed in the recent decades. However, even in this crucial time, many medical professionals, corporate executives, and others took advantage of the weak healthcare system and unsuspecting individuals to line their own pockets instead of providing needed health care services. As a good amount of these frauds takes place from within the system, its detection becomes all the more challenging.
Corporate frauds carried out by healthcare providers themselves in fact account for the most significant percentage of the overall fraud cases. Owing to their expert knowledge and position in the industry, these providers are able to create fraud schemes that effectively mimic legitimate transactions, with the assistance of complicit doctors and other medical professionals who have the capability to manipulate or bypass internal controls.
Ken Julian mentions that the frauds linked with government relief programs such as PRF especially surged up during the pandemic. This fund was basically designed to support American families, workers, and the healthcare providers in the battle against the Covid-19 outbreak. Apart from this, even episodes of false and counterfeit claims increased during the pandemic, which included fraudulent vaccines and fake vaccination records. Instances of creating a system of ‘kickbacks’ to physicians for accelerating the profits of pharmaceutical companies and other healthcare providers were also witnessed amidst the virus outbreak.