On November 20, 2024, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released the “Nursing Facility ICPG,” an industry-specific compliance program guidance for nursing facilities. 

Background

The Nursing Facility ICPG serves as a voluntary, nonbinding tool to assist facilities in reducing risks related to fraud, waste, and abuse, while…

The Law

The Corporate Transparency Act (the CTA), a law enacted by Congress requiring certain business entities to disclose beneficial ownership information (a BOI Report) to FinCEN, went into effect on January 1, 2024, and obligates reporting companies formed before January 1, 2024, to file BOI Reports on or before January 1, 2025.

The Challenge…

The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) announced on December 3 that it imposed a $1.19 million penalty on Gulf Coast Pain Consultants, a pain management practice in Florida, following a security breach that affected over 34,000 individuals.

Gulf Coast filed a breach notification report with OCR, as required…

A November 25 article in Part B News, “Third-party biller fraud may hook your practice, unless you protect yourself,” discussed the federal government’s recent fraud investigation of a medical biller in New York State and healthcare providers’ obligation to ensure the accuracy of their claims billing. Rivkin Radler’s Jeff Kaiser was quoted…

By January 1, 2025, millions of existing businesses must have filed certain information with the Financial Crimes Enforcement Network (FinCEN) to remain in compliance with the Corporate Transparency Act (CTA). As this deadline approaches, concern is growing among lawmakers. During a House Financial Services Committee hearing, committee members highlighted that many businesses have “no idea”…

On Thursday, December 12, in the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler Partner Eric D. Fader will present an update on the regulatory landscape for the provision of telehealth services, including the latest trends and recent changes to federal and state laws and rules. The program will take…

On October 31, Elevance Health filed suit against the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) to challenge the 2025 Star Ratings system used for Medicare Advantage and Part D plans. CMS published the final Star Ratings to the public on October 10 through the…

One of the nation’s largest urine drug testing laboratories recently settled with the federal government by paying $27 million to resolve alleged violations of the federal False Claims Act (FCA) and state statutes. Precision Toxicology (d/b/a Precision Diagnostics), headquartered in San Diego, allegedly provided medically unnecessary urine drug testing and offered free items to physicians…

On October 9, 2024, the United States Attorney’s office in the Eastern District of New York unsealed an indictment alleging that eight defendants defrauded Medicaid of approximately $68 million.1 The alleged scheme involved two adult day care programs and a home care financial intermediary, all owned and controlled by the same individuals, as well…

Eight individuals associated with two Brooklyn social adult day care centers and a home health care intermediary have been charged in an alleged $68 million Medicaid fraud scheme. The defendants, including owners and staff from Happy Family Social Adult Day Care Inc., Family Social Adult Day Care Inc., and Responsible Care Staffing, Inc., are accused…