The New York State Department of Health (DOH) adopted regulations effective February 22, 2023, which clarify certain resident admission and retention standards applicable to adult care facilities (ACFs), including adult homes, residences for adults, and enriched housing programs. The DOH stated that its rationale for the changes is to ensure that ACFs comply with the
Behavioral Health Provider Ordered to Repay $1.1 Million to NJ Medicaid Program
An audit by the New Jersey Office of the State Comptroller (OSC) found that John Gore, a licensed drug and alcohol counselor, improperly billed and received over $1 million in Medicaid payments for services provided between 2016 and 2020. Gore will be required to repay the sum of $1,160,371.
Significantly, Gore billed for clinical level
Pharma Coalition Files Suit Against HHS over OIG Advisory Opinion
On November 9, the Pharmaceutical Coalition for Patient Access (PCPA) filed an action against the U.S. Department of Health and Human Services (HHS) after HHS’s Office of Inspector General (OIG) determined that a proposed patient assistance model posed more than a minimal risk of fraud, waste, and abuse under the federal Anti-Kickback Statute (AKS). PCPA
Dental Care Alliance Settles Cyberattack Lawsuit for $3 Million
Dental Care Alliance, LLC (DCA) agreed to settle a class action lawsuit that arose out of a 2020 cyberattack. A hearing to approve the $3 million settlement was held on September 1.
DCA, based in Sarasota, Fla., is a dental services organization that provides practice support to over 390 affiliated dental practices across the U.S.
Dermatology Practice Settles Alleged HIPAA Violations
On August 23, the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) announced that Massachusetts-based New England Dermatology, P.C., d/b/a New England Dermatology and Laser Center (NEDLC), agreed to resolve alleged HIPAA violations for a fine of $300,640.
OCR commenced an investigation of NEDLC after the provider filed a breach report
NY Medical Practice Settles False Claims Act Allegations Related to “Incident-To” Billing
On August 3, North Country Neurology, P.C., a physician-owned medical practice located in Watertown, NY (the “Practice”), reached a settlement with the U.S. Attorney’s Office for the Northern District of New York to pay $850,000 for submitting false Medicare claims for payment.
Among other things, the Practice admitted to having submitted 120 claims between September
Transparency in Coverage Final Rule Took Effect on July 1
The Centers for Medicare & Medicaid Services’ Transparency in Coverage Final Rule took effect on July 1, following a six-month delay in implementation to allow payers to come into compliance.
The Final Rule requires group health plans and health insurance issuers offering non-grandfathered coverage in the group and individual markets to disclose online, in machine-readable
HHS Issues Guidance on Provider Use of Audio-Only Telehealth
On June 13, the U.S. Department of Health and Human Services (HHS) issued guidance to explain how audio-only telehealth can comply with HIPAA, while also emphasizing that this mode of telehealth services can expand healthcare access to individuals who may have limited internet and broadband capabilities.
In response to the COVID-19 pandemic in March 2020,
OIG Permits Arrangement Involving Physician-Owned Medical Device Company
In a recent Advisory Opinion, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) determined that an arrangement involving certain physicians who have an ownership interest in a medical device company that manufactures products that may be ordered by the physician owners (the “Company”) was not considered a suspect physician-owned
New NY Agency Established to Oversee PBMs
On May 11, New York Gov. Kathy Hochul announced the establishment of the Pharmacy Benefits Bureau within the State’s Department of Financial Services (DFS). The Bureau will handle the licensing and supervision of pharmacy benefit managers (PBMs), and in particular their impact on consumers and the cost of healthcare. The Bureau will also have authority