Last month, Pinnacle MultiCare Nursing and Rehabilitation Center (Pinnacle) filed a federal action to stop the U.S. Department of Health and Human Services (HHS) from recouping tens of millions of dollars in Medicare Part A payments made to Pinnacle during the COVID-19 pandemic. According to its Complaint, Pinnacle received a letter from
COVID-19
Medicare Telehealth Waivers Extended
By Douglas Menikheim on
On February 3, President Trump signed the Consolidated Appropriations Act, 2026 (H.R.7418), which extends certain Medicare telehealth flexibilities through December 31, 2027. These flexibilities were initially enacted by Congress in response to the COVID-19 pandemic and rising need for telehealth services.
The most important aspect of these flexibilities was that they permitted Medicare beneficiaries to…
Medicare Telehealth Flexibilities Expire
By Emily Manning on
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…
DOJ Targeting Healthcare for False Claims Act Enforcement
By Rivkin Rounds Staff on
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…
COVID-19 Pandemic Fraud Enforcement Efforts Overview
By Rivkin Rounds Staff on
Jeff Kaiser’s article, “COVID-19 Pandemic Fraud Enforcement Efforts Overview,” was published in the LexisNexis legal research tool, Practical Guidance.
In the article, Jeff offers a comprehensive overview of enforcement efforts related to COVID-19 pandemic fraud.
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Lab Co-Owners Acquitted in Alleged COVID-19 Testing Scheme
By Rivkin Rounds Staff on
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…
Court: Mailing Drugs to Patients’ Homes is a Potential Stark Law Violation
By Eric Fader on
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…
Lab Owner Pleads Guilty to COVID-19 Testing Fraud Scheme
By Rivkin Rounds Staff on
On October 1, the U.S. Attorney’s Office for the Northern District of Illinois announced that Zishan Alvi, the owner of a Chicago laboratory, pleaded guilty to one count of wire fraud for his role in a COVID-19 testing fraud scheme.
Alvi pleaded guilty to causing claims to be submitted to the U.S. Department of Health…
CA Dental Offices Pay $6.3M to Resolve FCA Claims
By Sean Simensky on
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).…
Lab Owner Pleads Guilty in Covid Test Kit Fraud Scheme
By Eric Fader on
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…