When a person in the United States comes down with an illness or injury and goes to the hospital, it’s comforting to know that their care provider will give them the best service possible. But, unfortunately, there are a number of procedures involved in this process that can turn out to be very expensive. In 2013, health care costs for the United States totaled over two trillion dollars—which is almost 18% of our gross domestic product (GDP). This number has been steadily increasing as more people discover that they need medical assistance.

As you might imagine, the large amounts of money involved with healthcare mean that there is a lot of fraud. Some forms of healthcare fraud include billing services or treatments that were never provided. In other cases, patients are often billed for more expensive procedures or medications than they need—or even at all! The unfortunate truth is that it’s hard to convict those who commit fraud. This is a complicated legal process that requires a specialized lawyer—like John LeBlanc of Manatt.

According to LeBlanc, healthcare fraud is difficult to prosecute because “there are many rules that have to be followed for someone to be convicted.” He goes on to explain that in addition, “the government isn’t the only party which is harmed by healthcare fraud. It also harms those who were charged with providing medical treatment.”

Even though it’s difficult to convict somebody of healthcare fraud, the government is still working to find and punish those who commit these crimes. The Federal Bureau of Investigation (FBI) has a special unit that focuses on investigating healthcare fraud—one of the FBI’s top priorities since 2009.

“The government is also putting together a task force to prosecute those who commit these crimes. This is important because individuals do not just commit healthcare fraud, but many times it’s done on a large scale basis.”

LeBlanc explains that combating healthcare fraud on such a large basis requires more than one law enforcement agency, and so the government formed this special task force.

The Department of Justice (DOJ) has made prosecuting healthcare fraud a priority for their agency as well. They created the Health Care Fraud Prevention and Enforcement Action Team or HEAT—which is designed to increase coordination between law enforcement agencies in order to shut down entire corrupt companies.

“What makes healthcare fraud so difficult to prosecute is the fact that there are so many different areas in which it can be committed. For example, you have physicians billing for services or treatments they didn’t provide, payment for services rendered to the wrong patient, kickbacks between doctors and medical supply companies—and that’s just naming a few.”

“It makes sense that you would need somebody who is very familiar with the legal process to handle these types of cases. This is why it’s important that if somebody suspects healthcare fraud, they need to turn the information over to people who are trained and equipped to address it.”


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