Your prescribed dose of health law news
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…
Earlier this month, the 11thh Circuit Court of Appeals joined the 5th, 6th, 9th and 10th Circuits in holding that the qui tam provisions of the False Claims Act (FCA) do not violate the Appointments Clause of the United States Constitution.
The case, United States ex rel. Zafirov v. Fla. Med. Assocs., LLC et…
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…
We have been reporting regularly on the increasing role that private equity has been playing in the healthcare industry and the oversight initiatives that a number of states have taken to address certain concerns resulting from this trend.
In a just-published article, Modern Healthcare cites data from Pitchbook and reports a 46% decrease in private…
Two Long Island ophthalmology practices have agreed to return $2.3 million in payments from state and federal government programs based on the ordering of unnecessary trans-cranial doppler ultrasounds (TCDs). The lawsuit brought by a whistleblower under the False Claims Act (FCA) against Mark D. Fromer, P.C., dba Fromer Eye Centers, and Floral Park Ophthalmology P.C.
On September 17, Rivkin Radler’s Jeff Kaiser will participate on a panel at the Practising Law Institute (PLI) “Life Sciences 2026: Navigating Legal Challenges in Drug and Device Industries” program in New York City. The panel is entitled “Enforcement Trends Impacting the Drug and Device Industries.”
Offered virtually and at PLI’s NY Conference Center at…
New York Medicaid providers should prepare now for significant changes in provider enrollment oversight. The New York State Department of Health (DOH), following direction from the Centers for Medicare & Medicaid Services (CMS), will require every Medicaid-enrolled provider in New York to complete revalidation over the next 24 months. The process will require coordination among…
With the New York Medicaid Program facing scrutiny by the U.S. Department of Health and Human Services (HHS) for a perceived lack of oversight and compliance integrity involving certain types of providers (including personal care and home health providers), the New York Department of Health (DOH) recently announced certain program administrative measures that seem designed…
The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently issued Advisory Opinion 26-16, concluding that the “food-as-medicine” program operated by a federally qualified health center, which provides weekly produce boxes or vouchers paired with periodic health assessments for financially needy patients with diabetes or hypertension, presents a low risk…
