Fraud and Abuse

Two Long Island ophthalmology practices have agreed to return $2.3 million in payments from state and federal government programs based on the ordering of unnecessary trans-cranial doppler ultrasounds (TCDs). The lawsuit brought by a whistleblower under the False Claims Act (FCA) against Mark D. Fromer, P.C., dba Fromer Eye Centers, and Floral Park Ophthalmology P.C.

With the New York Medicaid Program facing scrutiny by the U.S. Department of Health and Human Services (HHS) for a perceived lack of oversight and compliance integrity involving certain types of providers (including personal care and home health providers), the New York Department of Health (DOH) recently announced certain program administrative measures that seem designed…

The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently issued Advisory Opinion 26-16, concluding that the “food-as-medicine” program operated by a federally qualified health center, which provides weekly produce boxes or vouchers paired with periodic health assessments for financially needy patients with diabetes or hypertension, presents a low risk…

On July 1, 2026, the Centers for Medicare & Medicaid Services (CMS) proposed a new rule that included certain enrollment-related policy changes under the Home Health Prospective Payment System (HHPPS) designed to “reduce improper Medicare payments and protect beneficiaries.”[1]

As explained by CMS, “[t]he overarching purpose of the enrollment process is to help confirm…

Two New York residents were recently indicted in the Eastern District of New York federal court in Central Islip for conspiracy to commit healthcare fraud, among other charges. The defendants allegedly paid kickbacks and submitted fraudulent claims to government payors, including Medicaid, for transportation services that were either not provided or for which the mileage…

The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently issued a favorable Advisory Opinion (No. 26-14) to a pharmaceutical manufacturer that is proposing to offer free antibody testing to patients.

In the proposed arrangement, the manufacturer would offer free antibody testing to determine whether patients would qualify for a prescribed…

On June 16, The Department of Justice (DOJ) sued the New York Department of Health (DOH), the DOH Medicaid Director, and Public Partnerships LLC (PPL) – the Georgia-based company selected by DOH in 2025 to manage New York’s Consumer Directed Personal Assistant Program (CDPAP) – in federal district court.  The lawsuit alleges that the defendants…

On May 27, in furtherance of the March 16, 2026 Executive Order on Eliminating Fraud, Assistant Attorney General Brett A. Shumate issued a memo titled “Accelerating Review and Enhancing Enforcement in Benefits Fraud Matters.” The Memo announced new measures by the U.S. Department of Justice (DOJ) to strengthen False Claims Act (FCA) enforcement…

Health care providers may want to offer free or discounted services to help patients, and that instinct may be good. Most providers, however, don’t think of “free care” as a kickback issue in the same way they might think about gifts or rewards as a kickback issue. They should, because the Office of Inspector General…

The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently issued a favorable Advisory Opinion (No. 26-09) regarding certain free treatment that would be offered to patients of a pediatric dental clinic. Specifically, the clinic planned to offer free comprehensive orthodontic treatment to one select patient per year.

As a general…