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
FinCEN Engages in Outreach as CTA Deadline Looms
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”…
Telehealth for 2025: Federal and State Legal Changes and Trends
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…
Elevance Health Sues HHS and CMS Over Star Ratings System
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…
Drug Testing Lab to Pay $27 Million to Resolve FCA Claims
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…
$68 Million CDPAP Fraud Indictment Unsealed Amidst Industry Changes
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 Charged in $68 Million Brooklyn Medicaid Fraud Scheme
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…
CA Physician and Practice Resolve FCA Allegations for $3.8 Million
The U.S. Attorney’s Office for the Southern District of California announced on October 11 that Dr. Janette Gray and her former medical practice, The Center for Health & Wellbeing in San Diego, resolved False Claims Act (FCA) allegations by agreeing to pay $3.8 million.
Gray and her practice allegedly billed Medicare and TRICARE from 2012…
Court: Mailing Drugs to Patients’ Homes is a Potential Stark Law Violation
A recently issued federal court opinion confirmed that certain pre-COVID era prescribing restrictions are back in place. In July 2023, a nonprofit advocacy group, Community Oncology Alliance, filed suit against the U.S. Department of Health and Human Services (HHS) regarding provisions of the Stark Law. Stark prohibits physicians from referring Medicare and Medicaid patients to…
OCR Imposes $240,000 Penalty in HIPAA Ransomware Investigation
The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) imposed a $240,000 civil monetary penalty against Providence Medical Institute in connection with a ransomware attack that revealed vulnerabilities in the Institute’s systems and potential HIPAA violations.
The Institute was the victim of a series of ransomware attacks in 2018 that compromised…
Lab Owner Pleads Guilty to COVID-19 Testing Fraud Scheme
On October 1, the U.S. Attorney’s Office for the Northern District of Illinois announced that Zishan Alvi, the owner of a Chicago laboratory, pleaded guilty to one count of wire fraud for his role in a COVID-19 testing fraud scheme.
Alvi pleaded guilty to causing claims to be submitted to the U.S. Department of Health…