The owner of Sublime Medical Transportation in Schenectady County, New York was recently sentenced to three to nine years in state prison for orchestrating a large Medicaid fraud scheme. Muhammed Adnan Saeed netted over $700,000, along with more than $60,000 in unemployment benefits to which he was not entitled.

Between 2019 and 2023, Saeed routinely…

On July 2, the U.S. Department of Justice (DOJ) and Department of Health and Human Services (HHS) announced the formation of the DOJ-HHS False Claims Act Working Group to strengthen “their ongoing collaboration to advance priority enforcement areas” in combating healthcare fraud. The two agencies cited the long history of partnership between them in enforcing…

Cigna filed a lawsuit on June 24 in Manhattan federal court accusing Bristol Myers Squibb of unlawfully blocking generic versions of its blood cancer drug, Pomalyst, from entering the market. The suit also names Celgene, a Bristol Myers subsidiary that originally developed and marketed the drug. Cigna alleges that Celgene violated U.S. antitrust laws by…

The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) has announced another settlement for alleged violations of HIPAA. OCR investigated BayCare Health System, which serves central Florida, after a patient complained to OCR in 2018 that her medical record was accessed by an unauthorized individual.

The patient told OCR that she…

Tennr, a healthcare technology company focused on streamlining healthcare operations, recently announced the receipt of $101 million in funding. While the investment signals growing confidence in AI-enabled administrative tools, Tennr’s real innovation lies in the technology it has developed to address one of healthcare’s most persistent inefficiencies: the referral process.

The company’s proprietary AI model…

The Nassau County District Attorney recently charged Joseph Golyan, a Great Neck gastroenterologist, with collecting Social Security and other government benefits over a four-year period, while simultaneously billing Medicare for care he was providing to Medicare beneficiaries. He allegedly collected over $100,000 in disability benefits, while billing Medicare over $700,000, during the relevant period. The…

Last month, the head of the Criminal Division of the U.S. Department of Justice (DOJ), Matthew R. Galeotti, issued a Memorandum outlining DOJ’s enforcement priorities and policies for prosecuting white-collar crime, identifying three core tenets to guide prosecutors: “(1) focus; (2) fairness; and (3) efficiency.”

Among the areas of focus listed, the Memorandum identified as…

Ellipsis Health, a digital health startup based in San Francisco, recently announced that it raised $45 million in a Series A-1 funding round led by Salesforce Ventures, CVS Health Ventures, and Khosla Ventures. The funding will be used to further develop Sage, the company’s AI-powered care manager, and expand its use across the healthcare industry.…

The Centers for Medicare & Medicaid Services (CMS) recently published a press release rescinding its June 2022 guidance concerning hospitals’ obligations to pregnant women under the Emergency Medical Treatment & Labor Act (EMTALA). EMTALA is a federal law that requires hospitals to provide emergency care to all patients, regardless of their ability to pay.

The…

An article in the June 9 issue of Part B News, “To ease doctor-departing woes, write careful terms into the contract,” discussed best practices for medical practices’ employment contracts with their physician employees. Rivkin Radler’s Norton Travis was quoted in the article.

Norton suggested that practices try to enforce restrictive covenants where…

Two Pennsylvania nursing home operators were recently sentenced in federal court to pay more than $15 million in restitution in a healthcare fraud case. Comprehensive Healthcare Management Services, the operator of Brighton Rehabilitation and Wellness Center, and the affiliated operator of Mount Lebanon Rehabilitation and Wellness Center were convicted of making false statements in connection…