Whistleblowers and law firms may try to use skilled nursing providers’ own claims data in order to bring False Claims Act cases against them, according to a new report that analyzed healthcare fraud enforcement.
“As claims data and similar information become increasingly available to analytics firms, providers should expect to see more opportunistic FCA cases brought based on data analytics and for traditional relators (such as employees or former employees) to seek to bolster their cases through publicly-available reimbursement data,” legal analysts wrote in Bass Berry and Sims’ annual Healthcare Fraud & Abuse Review.
“These cases serve as an important reminder to providers to understand their own data because the government and relators certainly are endeavoring to do so,” they warned.
Long-term care providers have recently been targeted with cases that focused on medical necessity of services provided, according to the report. Several cases and settlements — on both the state and federal level — accused providers of not providing appropriate medical care, or care that was medically unnecessary and then billing government healthcare program.
Overall, healthcare fraud cases accounted for a large majority (87%) of all False Claims Act recoveries in 2019. Of the $3 billion in settlements and judgments, recoveries involving the healthcare industry totaled $2.6 billion, the report noted.
The report’s full findings are available here.
