Prosecuting Healthcare Fraud with Ileana Hernandez of Manatt

By admin / September 15, 2021

Ileana Hernandez of Manatt, Phelps & Phillips recently spoke with us about the firm’s healthcare litigation practice, representing healthcare organizations in civil and criminal cases, particularly in the areas of False Claims Act enforcement and reimbursement matters.

Hernandez stated, “Some of the most significant healthcare litigation of the past decade has been False Claims Act enforcement, and much of it is focused on Medicare and Medicaid. For example, in 2012 alone, there was $2.5 billion worth of settlements in cases involving healthcare fraud committed against the federal government by pharmaceutical companies. In fact, healthcare fraud is the largest category of False Claims Act recoveries.”

In addition to representing healthcare organizations, Hernandez is also involved in civil litigation associated with governmental investigations and enforcement actions regarding reimbursement issues. She shared that “the goal is always a positive resolution for my clients – helping them avoid negative public relations or negative outcomes from the litigation.”

Hernandez noted that healthcare organizations generally have a hard time responding to allegations made by the government. “Responding with a lawsuit is usually perceived as defensive. However, in cases involving allegations of fraud, they must be able to identify where those claims are coming from and respond accordingly.”

She added that litigation is not always the best option in these situations. “Negotiating with the government to reach a resolution in which they can avoid negative press or bad PR, in general, is often in the best interests of the organization.”

Hernandez shared that her experience has given her great insight into how governmental agencies handle healthcare investigations and enforcement actions, including Medicare and Medicaid Fraud False Claims Act cases. “It’s important to know what types of claims a government agency is going to bring against you, and the litigation process almost always has both positive and negative impacts – no one wants a case hanging over their head for years, but there are also considerations about the nature of the allegations and how it may affect your business.”

She explained that it is essential for healthcare organizations to protect themselves by understanding the government agencies, their processes, and how they approach these types of cases. “If you do not have any knowledge of what the investigation process will be like, how the allegations are being investigated, or who is involved in working on specific cases, you may find yourself in a less than desirable position after the investigation and litigation ends.”

Hernandez believes that healthcare organizations must understand they are not alone regarding False Claims Act enforcement and Medicare and Medicaid fraud investigations. “The government agencies involved in these types of cases often face similar challenges, such as limited resources dedicated to the number of cases they must work on. However, despite these challenges—as well as limitations imposed by jurisdictional boundaries—it is still important to provide an effective defense against allegations made by governmental agencies.”

She said it is vital for healthcare organizations to have a strong working relationship with their legal counsel to build a solid defense. “You will need to be able to rely upon your legal counsel to guide you through all aspects of that process, including understanding any potential risks, minimizing those risks, and finding a way that best protects the business.”

 

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