Healthcare fraud largely implies to the process of executing any fraudulent scheme or benefit program to fill up one’s own pockets and that of discerning healthcare providers. The aim of healthcare providers ideally should be to ensure the good health and well-being of the patients. Unfortunately, this industry also involves numerous unscrupulous individuals who engage in fraud and illegal activities for their own profits. Ken Julian particularly mentions that a good number of healthcare frauds are done by healthcare providers themselves, as they are able to mimic legitimate transactions with complicit medical professionals with ease.
Healthcare frauds are among the major types of white collar crimes across many parts of the world, including the United States. The Covid-19 pandemic especially placed this problem on the map and attracted the attention of both mass media and the general public towards it. Ken Julian mentions that while recently more stories associated with healthcare frauds can be seen on the news today, this is not at all a new problem. In fact, it has been a big business even prior to the Obama Administration’s Affordable Care Act. As a partner of the health care litigation practice at Manatt, Phelps & Phillips, Ken has a good knowledge about the sphere of fraud cases associated with the healthcare domain. He additionally mentions that previously media used to be more focused on scandals like Enron, WorldCom, and Adelphi cases, while the healthcare fraud prosecutions were lost somewhere in the background. Most cases associated with healthcare frauds remained in the back pages of the newspapers, and hence hardly caught the attention of the mass audience. This trend, however, began to change during the times of Covid-19 crisis, when the healthcare system came under immense pressure. During the peak months of the pandemic, Covid-19 linked stories dominated both media headlines and public consciousness, which ultimately led to raising public awareness about the enormity of the healthcare fraud cases. The United States Department of Justice additionally put the investigation of healthcare fraud at the forefront of their major priorities.
The Covid-19 pandemic impacted almost every domain across the world and underlined weaknesses in the systems meant to serve humanity, the healthcare sector being the most affected one. Ken Julian mentions that healthcare frauds hurt just about everyone in society. The diversion of funds taking place due to fraud augments the cost of providing a full range of legitimate medical services to patients who actually are in desperate need. Indirectly, healthcare fraud cases have a hand in reducing coverage benefits, increasing premiums incurred by individuals and their employers, and redefining eligibility for programs such as Medicaid. Within the pandemic, cases of fraudulent vaccines and fake vaccination records came into being, apart from fraud associated with government relief programs such as PRF or Provider Relief Fund. PRF was developed as a part of the more expansive Coronavirus Aid, Relief, and Economic Security Act.