On October 15, Assistant Attorney General Colin M. McDonald issued a Memo announcing new coordination between the National Fraud Enforcement Division (NFED) and the U.S. Department of Health and Human Services Office of Inspector General (OIG) regarding self-disclosure in criminal health care fraud matters.[1]

The Memo notes that in the area of health care…

As previously discussed here, a growing number of states are increasing oversight and regulation of healthcare transactions involving private equity (PE), hedge funds and other investors, as well as agreements between management services organizations (MSOs) and physician groups. The stated rationales for such oversight are concerns over quality of patient care, increased consumer pricing…

Earlier this month, an owner of Brooklyn-based Happy Family Social Adult Day Care Center, Inc., Family Social Adult Day Care Center, Inc. and Responsible Care Staffing, Inc., a home health care fiscal intermediary operating under the Consumer Directed Personal Assistance Program (CDPAP), pleaded guilty to defrauding Medicaid of approximately $65 million for social adult day…

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…