On August 23, Johnson & Johnson (J&J) announced changes to its 340B Drug Pricing Program discount available to disproportionate share hospital (DSH) Covered Entities on purchases of two of J&J’s most popular drugs, STELARA and XARELTO.
As of October 15, J&J will make a 340B discount on these drugs available through a rebate. According to
On May 16, the U.S. Attorney’s Office for the District of Massachusetts announced that Cape Cod Hospital agreed to pay $24.3 million to resolve alleged violations of the federal False Claims Act (FCA) for knowingly failing to follow Medicare’s requirements for certain procedures performed.
Beginning in 2015, the hospital offered transcatheter aortic valve replacement (TAVR)
The U.S. Attorney’s Office for the Eastern District of Michigan announced on May 8 that Michigan Ear Care PLLC and James Aronovitz, D.O. agreed to pay over $2 million to resolve allegations that they submitted false claims to the Medicare and Medicaid programs.
Aronovitz allegedly billed for ear care services under his own National Provider
On April 11, the medical director and the owner of a pain clinic in Kentucky were sentenced to prison for their roles in a scheme to defraud federal healthcare programs and commercial insurance companies for medically unnecessary urine drug testing. Previously, in March 2023, the clinic’s medical director, William Lawrence Siefert, was convicted of healthcare
On April 10, Virginia-based nurse practitioner Daphne Jenkins was sentenced to prison for her participation in a $7.8 million telemedicine fraud scheme that involved medically unnecessary orders for durable medical equipment (DME). As part of the scheme, Medicare claims were submitted based on false documentation and tainted by kickbacks.
The orders Jenkins signed were pre-populated
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
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.
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
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
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