The American Relief Act, 2025, signed into law on December 21, included a short-term extension of certain telehealth waivers that went into effect in the early days of the COVID-19 Public Health Emergency. These waivers, for telehealth services provided to Medicare beneficiaries, had been set to expire on December 31, but have now been
Third-party biller fraud may hook your practice, unless you protect yourself
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
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
Radiology Practice to Pay $8.9M to Resolve FCA/AKS Claims
The U.S. Attorney’s Office for the Southern District of Texas announced on August 20 that National Interventional Radiology Partners PLLC (NIRP) and its founder and CEO will pay $8,884,091 to the United States to resolve alleged violations of the federal False Claims Act (FCA) and Anti-Kickback Statute. NIRP and Dr. Andrew Gomes allegedly illegally paid
NJ Biopharma Company Settles FCA/AKS Case for $5M+
The U.S. Department of Justice announced on July 24 that Admera Health LLC, a New Jersey-based biopharmaceutical research and clinical laboratory testing company, agreed to pay $5,389,648 to resolve kickback allegations brought by two whistleblowers under the False Claims Act (FCA).
Admera provides biopharmaceutical research services for healthcare institutions and provided clinical laboratory testing services
Guilty Plea in $50 Million Medicare Fraud Scheme
Manishkumar Patel of Pelham Manor, NY recently pleaded guilty in connection with a healthcare fraud and kickback scheme involving the sale of fraudulent prescriptions to pharmacies, durable medical equipment suppliers, and laboratories, which then obtained payments from Medicare. The scheme resulted in $50 million in fraudulent claims from 2019-22.
Patel and a co-conspirator worked with
Lab Owner Pleads Guilty in Covid Test Kit Fraud Scheme
Robert Clark of Pompano Beach, Florida recently pleaded guilty to his role in a Medicare fraud scheme. Clark and his co-conspirators purchased Medicare Beneficiary Identification numbers unlawfully and then billed Medicare for over-the-counter COVID-19 test kits. The conspirators also paid illegal kickbacks and bribes to marketers for referring Medicare beneficiaries for genetic tests.
Approximately $30
NYS Maintains Independent Practice Authority for NPs
The New York State 2024-2025 budget includes legislation that extends until July 1, 2026 the independent practice authority for certain qualified nurse practitioners with over 3,600 practice hours.
Our prior post on this topic provides additional details on which nurse practitioners qualify to practice independently, that is, without a written practice agreement or collaborative relationship
NJ Hospital and Investors to Pay $30.6 Million to Settle FCA Claims
The U.S. Department of Justice recently announced that Silver Lake Hospital, a long-term care hospital in Newark, New Jersey, and some of its investors agreed to pay $30.6 million to settle claims that they violated the False Claims Act (FCA) and the Federal Debt Collection Procedures Act (FDCPA). The hospital allegedly overbilled Medicare by claiming
OIG Advisory Opinion Blesses Gift Card Plan
A recent Advisory Opinion (No. 23-15) from the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) concluded that a healthcare consulting company’s plan to offer gift cards to physician practices in exchange for referring potential new customers to the company does not violate the federal Anti-Kickback Statute (AKS).
The consulting company