The New York State Department of Health (DOH) recently issued Dear Administrator Letter DRS 26-05 announcing the release of an updated Nursing Home Incident Reporting Manual. Nursing home operators should review the updated manual to confirm that their incident reporting policies, investigation practices, documentation tools, escalation protocols, and staff training reflect current DOH expectations.…

On October 1, Assistant Attorney General Colin M. McDonald issued a memo on “Corporate Enforcement in the Fight Against Fraud” (the “Memo”), announcing an “all-tools approach to investigating and prosecuting our health care, government, tax, and trade fraud priorities.”[1] The Memo includes directives to ensure that the National Fraud Enforcement Division (NFED) “efficiently and…

The U.S. Department of Justice (DOJ) announced on September 24 that the Chief Operating Officer of Fast Lab Technologies, LLC pleaded guilty to conspiracy to commit healthcare fraud in connection with a nationwide COVID-19 billing scheme that resulted in more than $500 million in fraudulent claims.

According to DOJ, the New York-based laboratory company offered…

On September 23, the Cigna Group announced a collaboration with OpenAI to develop more personalized support for patients with complex conditions, initially focusing on cancer care. The initiative will integrate OpenAI’s artificial intelligence capabilities into Cigna’s clinical workflows and patient-facing services.

One of the first planned capabilities would help oncology nurses and case managers at…

This month, the U.S. Department of Justice (DOJ) made revisions to the Justice Manual in two areas affecting False Claims Act (FCA) prosecutions: (1) the use of sub-regulatory guidance; and (2) DOJ’s exercise of its dismissal authority.

Sub-Regulatory Guidance

One of the revisions “reinstates and builds upon” polices set forth in prior DOJ memos issued…

On September 17, the U.S. Court of Appeals for the Second Circuit reaffirmed that the No Surprises Act (NSA) does not provide out-of-network providers with a private right of action to enforce payment determinations issued through the independent dispute resolution (IDR) process.

The plaintiff in East Coast Advanced Plastic Surgery, LLC v. Cigna Health and …

In August, Assistant Attorney General Colin McDonald issued a memorandum (the “Memo”) announcing the enforcement priorities of the National Fraud Enforcement Division (also known as NFED), which the U.S. Justice Department (DOJ) established in April of this year.[1]   

McDonald noted that NFED “has quickly established a nationwide footprint” since launching in April and…

A newly introduced federal bill aimed at prohibiting the corporate practice of medicine, titled the “Stop Corporate Takeovers of Physicians Act,” was introduced on September 16 by several Democratic lawmakers in the Senate and House. The bill would impose sweeping restrictions on corporate ownership and control of medical practices and could significantly affect…

An article in the September 17 issue of Part B News, “Medicare exclusions not just for OIG anymore: RFK Jr.,” discussed various types of possible disciplinary actions against Medicare providers. Rivkin Radler’s Chris Kutner was quoted in the article.

“I don’t think there’s a percentage of the population that really understands the…