Jack Wenik, Member of the Firm in the Health Care & Life Sciences and Litigation practices, in the firm’s Newark office, authored an article in HFMA Focus, titled “Trends in Fraud and Abuse Investigations Since COVID.”

Following is an excerpt (see below to download the full article in PDF format):

For healthcare providers such as hospitals, physician groups, nursing homes, etc. and the executives and employees who run them, we are at a unique moment in history. The, hopefully, tail-end of the pandemic related to COVID-19 has coincided with a change in administration via the election of President Biden. These two momentous events have had an enormous effect on fraud and abuse enforcement at both the state and federal levels. Some of these changes in direction and emphasis are readily apparent while others are only starting to emerge.

In this article, I identify and describe a handful of trends in fraud and abuse enforcement and provide some practical insights as to what these changes mean for the healthcare industry. This article does not cover fraud investigations emanating from the enormous relief funds enacted to protect the healthcare system and the economy at large from the economic dislocation caused by COVID-19. To be sure, the CARES Act signed on March 27, 2020 included billions of dollars for such measures as the Provider Relief Fund to assist healthcare providers from lost revenues attributable to COVID-19 as well as billions more in the Paycheck Protection Program to provide relief to businesses and their employees more generally. There can be little doubt that many abused these programs and investigations and prosecutions will surely follow. However, this is to be expected with any large-scale relief program. What is more intriguing, and the focus of this article, is how COVID-19 and the change in administrations has altered the landscape of fraud and abuse investigations more generally.

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