Your prescribed dose of health law news
Westside Behavioral Care Inc., a Colorado mental health clinic, recently sued Kaiser Foundation Health Plan of Colorado for prematurely terminating its participation agreement. Kaiser terminated the agreement in an effort to increase the provision of services through a less costly telehealth model.
The clinic is alleging that the early termination disrupted care for more than…
The New York Attorney General’s Office imposition of a $250,000 penalty on MVP Health Care for maintaining an inaccurate mental health provider directory riddled with “ghost” providers was recently discussed here. The problem, however, extends beyond New York. The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently issued a…
The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) has issued a favorable Advisory Opinion for a non-profit foundation receiving donations from an affiliated company. The company in this case offers family-based therapy for children with a redacted “Disorder” (presumably autism), where the goal of the therapy sessions is to train…
The New York Attorney General’s office recently announced an agreement with MVP Health Care under which the insurer will pay $250,000 in penalties, fees, and costs to the state for maintaining an inaccurate mental health provider directory. The settlement is the first arising out of an investigation of so-called “ghost networks” by Attorney General Letitia…
Ellipsis Health, a digital health startup based in San Francisco, recently announced that it raised $45 million in a Series A-1 funding round led by Salesforce Ventures, CVS Health Ventures, and Khosla Ventures. The funding will be used to further develop Sage, the company’s AI-powered care manager, and expand its use across the healthcare industry.…
On January 29, the New York State Office of the Medicaid Inspector General (OMIG) published its 2025 Work Plan, which provides a preview of the OMIG’s program integrity initiatives for the upcoming year. While this post highlights several areas that the OMIG will focus on, Medicaid providers should refer to the Work Plan for…
The U.S. Attorney’s Office for the District of Connecticut recently announced that Supportive Care Holdings, LLC and its related companies agreed to pay the federal government nearly $4,600,000 to resolve allegations of submitting false claims. The Supportive Care companies provide behavioral health services via telehealth to patients residing in skilled nursing facilities.
Supportive Care’s companies…
The owner of Bergen Alliance Counseling Services in Paramus, New Jersey pleaded guilty to a run-of-the-mill healthcare fraud scheme in District Court in Newark on March 19. Maria Cosentino of Garfield, a licensed clinical social worker, admitted to billing private healthcare programs for counseling sessions that did not take place.
The practice provided counseling services…
A March 11 article in Part B News, “Warning: Minor Errors Can Mean Big Takebacks for AWV Claims,” discussed how compliance shortcomings can cause problems for claims to Medicare for annual wellness visits (AWVs). Rivkin Radler’s Mary Aperance was quoted in the article.
“Routine internal audits should be conducted to hone in…
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.
