On February 6, the U.S. Department of Health and Human Services (HHS) announced a $4.75 million settlement with Montefiore Medical Center (MMC) for a breach of unsecured electronic protected health information (ePHI). The settlement stems from an internal investigation that found that an employee of the New York hospital system sold patient information to an
Mary Aperance
CT Psychologists Convicted for Medicaid Fraud
On December 19, Michael Lonski, a Greenwich psychologist, was sentenced to a 27-month prison term and three more years of supervised release for a scheme to defraud Medicaid. Lonski submitted over 80,000 claims from 2014 to 2019, and in calendar year 2017 he submitted claims for services on all but one day—including holidays and weekends.
FCA Complaint Filed Against Interventional Radiologist
On May 2, the U.S. Attorney’s Office for the Eastern District of Pennsylvania announced that the United States has filed a complaint under the False Claims Act (FCA) against James McGuckin, an interventional radiologist. The complaint alleges that McGuckin and his affiliated entities billed Medicare and the Federal Employees Health Benefits Program for more than…
NYS DOH Clarifies ACF Admission and Retention Standards
On April 25, the New York State Department of Health (DOH) issued a Dear Adult Care Facility Administrator Letter (DACF #23-15) after it came to the DOH’s attention that some ACF operators have interpreted recent regulatory changes (discussed here) to operate as an absolute bar on the admission and retention of individuals…
NYS DOH Launches New Electronic Incident Reporting Form
The New York State Department of Health (DOH) issued Dear Adult Care Facility Administrator Letter (DACF) #23-02 on March 29 announcing that adult homes, enriched housing programs, and assisted living residences will have a new electronic Incident Reporting mechanism—the Drupal Survey. The Drupal Survey will replace the previous incident reporting method via the Health Commerce…
NYS DOH Updates Adult Care Facility Admission and Retention Standards
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…