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
Avoid Common Mistakes in Malpractice Cases
An article entitled “Avoid Common Mistakes in Malpractice Cases,” which appeared in the March 2023 issue of Healthcare Risk Management magazine, discussed how to handle an allegation of medical malpractice. Rivkin Radler’s Eric Strober was quoted extensively in the article.
Eric pointed out that one of the biggest mistakes would be altering a
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
Healthcare Fraud Tops DOJ’s Annual False Claims Act Report – Again!
Rivkin Radler’s Michael Sirignano authored an article for the March 2 issue of the New York Law Journal entitled “Healthcare Fraud Tops DOJ’s Annual False Claims Act Report – Again!” The article discussed a report issued by the U.S. Department of Justice detailing the settlements and judgments it obtained under the federal False
Implementing an Effective Compliance Program: A Focus on Elements One and Two
In the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler’s Bob Hussar will discuss the first two required elements of an Effective Compliance Program:
1. Policies and Procedures; and
2. Compliance Officer/Compliance Committee
Bob is a partner in Rivkin Radler’s Compliance, Investigations & White Collar and Health Services practice groups.
Be careful about upcoding; DOJ may come after it as a false claim
A recent article in Part B News, “Be careful about upcoding; DOJ may come after it as a false claim,” discussed how the U.S. Department of Justice frequently prosecutes improper billing of CPT codes for Medicare patients. Rivkin Radler’s Jeff Kaiser was quoted in the article.
“Sometimes, a provider will upcode a
OMIG Update: Compliance, Self-Disclosure, and Managed Care Fraud, Waste and Abuse Guidance Posted
On the heels of publishing their final regulations, on January 31, the New York Office of the Medicaid Inspector General (OMIG) released a variety of guidance documents addressing compliance programs; self-disclosure; and Medicaid managed care fraud, waste and abuse prevention programs. The guidance documents can be found at:
OMIG’s FINALIZED Regulations: What You Need to Do – NOW!
In the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler’s Bob Hussar, Ashley Algazi and Mary Connolly will present “OMIG’s FINALIZED Regulations: What You Need to Do – NOW!”
On December 28, the Office of Medicaid Inspector General (OMIG) released their final compliance and self-disclosure regulations. The regulations implement 2020
An Insurance Fraud Year in Review
Rivkin Radler’s Michael Sirignano authored an article for the January 5 issue of the New York Law Journal entitled “An Insurance Fraud Year in Review.” The article discussed various types of healthcare fraud for which the perpetrators were sentenced in 2022.
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A Survey of OIG’s 2022 Advisory Opinions
- Discuss select Advisory Opinions from last year on a variety of topics, including use of