The Office of Inspector General (OIG) recently announced that it is ramping up its efforts to fight healthcare fraud, and one of the tools it has in this fight is the False Claims Act. The last several months have seen several high-profile cases filed as part of this effort. Unfortunately, as the healthcare industry continues to attract large sums of money through government-funded programs such as Medicare and Medicaid, those cases are likely to continue. One attorney who is very familiar with these cases is John LeBlanc of Manatt, Phelps & Phillips. LeBlanc has a long history of representing pharmaceutical and medical device companies, and he is currently working on several qui tam lawsuits involving Medicare fraud.
In this interview, LeBlanc discusses the recent uptick in False Claims Act activity, including the qui tam lawsuits filed by whistleblowers. He also discusses some of the criteria that OIG uses when deciding which cases to pursue and goes through several of his current cases involving Medicare fraud.
In the last few months, what percentage of your work has been devoted to healthcare fraud cases?
“I’d say about half. It’s a significant amount. I think it represents a trend that we’ll probably see going forward, with OIG being more aggressive in pursuing these types of matters. They have many tools available to them – the False Claims Act is one of them and the civil monetary penalties law under HIPAA. So they have several tools at their disposal to use in these types of cases.”
Do you think that’s going to be the case going forward? That OIG is going to dedicate more resources toward healthcare fraud cases?
“I do because the OIG has a limited number of people that do this, so they have to pick and choose which ones they think are the most important. They have an excellent staff who understand these types of cases. I can’t say enough about how good they are.”
Is it the same group of attorneys working on these False Claims Act cases? Do they specialize in that?
“They have a number of people who work on them, and the larger OIG staff supports them. We’ve had a chance to work with some outstanding and talented lawyers when we worked on matters involving Medicaid.”
What are your thoughts about the criteria that OIG is using to decide which cases it pursues?
“I think it’s many factors. It involves the strength, pertinence, and merit of the allegations and things like whether or not they’d be able to get cooperation from other people who may come forward and assist them in the case. They’re looking for important cases to achieve their mission: correcting fraud, waste, and abuse in the healthcare system. It involves things like whether or not there has been an impact on public trust, which I think is more of a factor that they consider now than it used to be.”
“I think another factor that they consider is whether or not it would have an impact on the larger fraud scheme involving public health programs. So, a matter might involve a small amount of money, but the total fraud scheme could be worth millions and millions of dollars – maybe even more – so if they can stop something like that early on, it prevents public health programs from having to pay for all that stuff. In those larger schemes, the government may have been paying for things that it shouldn’t have, so they want to stop that.”