Here’s a selection of recent healthcare frauds from New Jersey. On April 17, John Sher of Margate was sentenced to 37 months in prison and ordered to pay $2.77 million in restitution and $327,987 in forfeiture for defrauding New Jersey state and local health benefits programs and other insurers. Sher and a co-conspirator recruited state
Fraud Week: NY Transportation Company Owners Jailed, Fined
Transportation fraud isn’t new, but it’s new to Rivkin Rounds. The U.S. Attorney’s Office for the Southern District of New York recently announced that Yonkers resident Julio Alvarado was sentenced to 95 months in prison for leading a scheme that billed Medicaid for fraudulent transportation claims. From 2017 to 2020, KJ Transportation C Services Inc.
Fraud Week: Focus on Florida Fraud
To celebrate the opening of Rivkin Radler’s first Florida office, we’ll cover some recent Florida frauds. The U.S. Department of Justice (DOJ) announced on April 20 that two Miami residents, Dean Zusmer and Lawrence Alexander, were sentenced to prison for their roles in a Medicare fraud scheme. Zusmer, a chiropractor, and Alexander, an orthopedic surgeon
Fraud Week: DOJ Announces COVID-Related Fraud Sweep
The U.S. Department of Justice (DOJ) announced on April 20 that it has brought criminal charges against 18 defendants across the U.S. for various fraud schemes related to the COVID-19 pandemic. The DOJ seized more than $16 million in cash and other proceeds from the schemes, which resulted in more than $490 million in false
OIG to Update Compliance Program Guidance Documents
On the heels of New York’s Office of the Medicaid Inspector General (OMIG) releasing updated compliance requirements, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) announced today that it will also be updating and modifying its voluntary compliance guidance documents.
The OIG’s stated purpose for the modifications is to improve
PHE HIPAA Enforcement Discretion to Expire, Restoring Compliance Obligations
The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) announced on April 11 that the Notifications of Enforcement Discretion issued under HIPAA and the HITECH Act during the federal COVID-19 public health emergency (PHE) will expire when the PHE ends on May 11.
The four Notifications of Enforcement Discretion that will
Surgeon Settles Simultaneous Surgery Suit
The U.S. Department of Justice announced on February 27 that the University of Pittsburgh Medical Center (UPMC), James Luketich, its Chair of Cardiothoracic Surgery, and University of Pittsburgh Physicians have agreed to pay $8.5 million to settle a qui tam suit brought by a former UPMC cardiothoracic surgeon. The suit, brought under the False Claims
NY Pharmacist in Oxycodone Scheme Pleads Guilty
On February 17, Daniel Russo, a Long Island resident, pleaded guilty in federal court in Brooklyn to multiple charges in connection with illegally distributing oxycodone. Russo faces decades in federal prison when he is sentenced.
Russo owned and operated Russo’s Pharmacy in Far Rockaway, Queens. From 2011 to 2014, he filled thousands of fraudulent prescriptions
COVID-19 PHE Ending on May 11
As many of our readers are no doubt already aware, the U.S. Department of Health and Human Services announced on February 9 that the COVID-19 public health emergency (PHE) will end on May 11. The announcement gave payers, providers and states 90 days to prepare for policy changes.
As discussed here, most current Medicare
Fraud Week: So Much Fraud, So Little Time
For those who just can’t get enough fraud, here are some of the “leftovers” from this edition of Fraud Week that your editor thought noteworthy.
Read about a pharmacy biller’s fake copay assistance scheme:
Genetic testing kickback schemes
In TX: https://www.justice.gov/opa/pr/laboratory-owners-and-executives-charged-health-care-kickback-scheme
And here’s a big one in GA: https://www.justice.gov/opa/pr/lab-owner-convicted-463-million-genetic-testing-scheme-defraud-medicare
DME kickback