VIDEO: Health-Care Fraud Fighting Still Going Strong Under Trump

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By James Swann

President Trump’s health-care watchdogs are not relaxing their pursuit of perennial fraud targets; in fact, they’re intensifying prosecution of certain kinds of misconduct, health-care attorney Gejaa Gobena told Bloomberg BNA.

The Trump administration is not going any easier than Obama’s on providers, who are seen by law enforcement as the epicenter of fraud, Gobena, an attorney with Hogan Lovells in Washington, said. For example, the government increasingly pursues cases using medical necessity data to argue that unnecessary services were billed, Gobena said in a recent video interview.

While there’s been some concern over the level of funding for anti-fraud efforts, the Trump administration’s proposed budget for fiscal year 2018 actually would increase anti-fraud and abuse funding, Gobena said.

The budget called for $5.25 billion in funding for the Health Care Fraud and Abuse Control program over the next 10 years, up slightly from the Obama administration’s $5.1 billion in proposed funding in its FY 2017 budget request.

Although the Obama administration prosecuted a number of fraud cases associated with opioids, Gobena said the Trump administration has stepped up the effort. For example, a July health-care fraud “takedown” included a large number of opioid cases, and several pharmaceutical manufacturers and pharmacy benefit managers recently settled opioid fraud cases, Gobena said.

The July takedown charged more than 400 people with health-care fraud, including 56 doctors who were associated with opioid fraud schemes.

Gobena identified three steps to deter health-care fraud, including having a strong and well-funded compliance program. He also said providers should be proactive and self-disclose internal problems, and should make sure to remediate any issues.

To contact the reporter on this story: James Swann in Washington at jswann1@bna.com

To contact the editor responsible for this story: Kendra Casey Plank at kcasey@bna.com

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