COVID-19

As of September 30, several temporary Medicare telehealth flexibilities that were put in place during the COVID-19 pandemic officially came to an end. One of the most significant changes involves the site requirement for telehealth services. Medicare beneficiaries can now only receive telehealth services other than behavioral or mental health services from specific originating sites…

An article in the August issue of Healthcare Risk Management, “DOJ Targeting Healthcare for False Claims Act Enforcement,” discussed recent enforcement activity by the U.S. Department of Justice (DOJ) under the False Claims Act (FCA). Rivkin Radler’s Jeff Kaiser was quoted in the article.

Jeff predicted that the FCA will continue to…

A Florida jury recently found two laboratory co-owners of Innovative Genomics LLC (“IGX”) not guilty in connection with an allegedly fraudulent COVID-19 testing scheme.

The Government alleged that from November 2019 through June 2023, the co-owners conspired to defraud Medicare and the Health Resources and Services Administration COVID-19 Uninsured Program by billing healthcare benefit plans…

A recently issued federal court opinion confirmed that certain pre-COVID era prescribing restrictions are back in place. In July 2023, a nonprofit advocacy group, Community Oncology Alliance, filed suit against the U.S. Department of Health and Human Services (HHS) regarding provisions of the Stark Law. Stark prohibits physicians from referring Medicare and Medicaid patients to…

West Coast Dental Administrative Services LLC, which operates more than 40 dental and specialist locations in Southern California, and its affiliates have paid $6.3 million to resolve alleged violations of the False Claims Act (FCA). The alleged violations were in connection with loans received by the affiliated offices pursuant to the Paycheck Protection Program (PPP).…

Robert Clark of Pompano Beach, Florida recently pleaded guilty to his role in a Medicare fraud scheme. Clark and his co-conspirators purchased Medicare Beneficiary Identification numbers unlawfully and then billed Medicare for over-the-counter COVID-19 test kits. The conspirators also paid illegal kickbacks and bribes to marketers for referring Medicare beneficiaries for genetic tests.

Approximately $30…

On February 26, David Weathers of the Bronx pleaded guilty in federal court in New Jersey for his role in a COVID-19 kickback conspiracy. The government had charged Weathers with soliciting kickbacks in return for referrals of COVID-19 test samples, in violation of the federal Anti-Kickback Statute (AKS).

At the other end of the scheme…

The 2024 Medicare Physician Fee Schedule final rule, released by the Centers for Medicare & Medicaid Services (CMS) earlier this month, extended certain telehealth-related flexibilities that were implemented during the early days of the COVID-19 pandemic. CMS issued a Fact Sheet summarizing the telehealth updates, as well as other important Medicare policy changes.

Until 2020…