Fraud and Abuse

On March 11, the U.S. Department of Justice and U.S. Attorney’s Office announced that Aetna, a national health insurer, has agreed to pay $117,700,000 to settle alleged violations of the False Claims Act (FCA). The government was investigating Aetna for submitting inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan beneficiaries, which increased Aetna’s…

Last month, the U.S. Department of Health and Human Services’ Office of Inspector General (“OIG”) published Medicare Advantage Industry Segment-Specific Compliance Program Guidance (“Guidance”). OIG described the Guidance as “OIG’s updated and centralized source of voluntary compliance program guidance for Medicare Advantage.”[1] The impetus for creating the Guidance was “the growing popularity” and OIG’s…

Last month, Dr. Mehmet Oz, Administrator of the Centers for Medicare & Medicaid Services (CMS), accompanied by other CMS officials, visited with home health and hospice providers and related industry associations to discuss ways to strengthen program integrity enforcement.  CMS was reacting to calls from industry stakeholders and members of Congress to get a handle…

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services recently issued an unfavorable Advisory Opinion (No. 25‑12) addressing a home health care agency’s proposal to offer sign‑on bonuses to prospective employees who are in a position to refer patients (usually family members) to the employer for home care. The…

Earlier this month, the New York Department of State (DOS) published a warning to consumers following an extensive investigation of so-called “med spas.” The DOS’s Division of Licensing led the investigation, in which 223 businesses were inspected.

The publication initially addressed the need for businesses that hold themselves out to the public as med spas…

In an unfavorable Advisory Opinion issued last week[1], the Office of Inspector General, U.S. Department of Health and Human Services (OIG) found that a home care agency’s plan to market sign-on bonuses to prospective employees with the intention of employing those individuals to provide services to family members could result in sanctions for…

A New York physician was recently sentenced in federal court for receiving kickbacks in exchange for ordering medically unnecessary brain scans. Vishnudat Seodat of Mattituck had practiced for 36 years and operated three “New York Health” offices on Long Island. He announced his retirement in a letter to patients last month.

From 2013 to 2019…

The 21st Century Cures Act (Cures Act) required states to adopt electronic visit verification (EVV) systems for Medicaid-covered personal care services (PCS) by January 1, 2020 and for home health care services (HHCS) by January 1, 2023. According to the Centers for Medicare and Medicaid Services (CMS), the EVV requirement was imposed “in response to…

The U.S. Department of Justice recently announced a settlement with Patients Choice Laboratories (“PCL”), a diagnostic laboratory headquartered in Indianapolis, Indiana, under which PCL will pay over $9.6 million to resolve allegations that it violated the federal False Claims Act (FCA) and Anti-Kickback Statute (AKS). The government alleged that the lab knowingly submitted claims to…

The 2025 National Health Care Fraud Takedown, announced in June, was the largest in history, with 325 defendants charged (including 96 providers) in 50 federal districts. In all, the charged schemes involved more than $14 billion in intended loss, and more than $245 million in cash, luxury vehicles, cryptocurrency and other assets were seized. These…