Fraud and Abuse

An article in the March 20 issue of the Report on Medicare Compliance, “New NYS Compliance-Program Requirements May Be Useful Everywhere as a ‘Fresh Look,’” discussed the final compliance and self-disclosure regulations released by the New York Office of Medicaid Inspector General (OMIG) on December 28. Rivkin Radler’s Bob Hussar was quoted in…

The Westchester District Attorney’s office announced on March 17 that it has charged Cesar Masso, a 78-year-old Queens resident, with illegally practicing dentistry without a license. Masso operated a dental practice in White Plains under the name East Post Dental, performing professional services including extractions, examinations, and delivering anesthetics, and has been charged with three…

An audit by the New Jersey Office of the State Comptroller (OSC) found that John Gore, a licensed drug and alcohol counselor, improperly billed and received over $1 million in Medicaid payments for services provided between 2016 and 2020. Gore will be required to repay the sum of $1,160,371. 

Significantly, Gore billed for clinical level…

Rivkin Radler’s Michael Sirignano authored an article for the March 2 issue of the New York Law Journal entitled “Healthcare Fraud Tops DOJ’s Annual False Claims Act Report – Again!” The article discussed a report issued by the U.S. Department of Justice detailing the settlements and judgments it obtained under the federal False…

In the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler’s Bob Hussar will discuss the first two required elements of an Effective Compliance Program:

1. Policies and Procedures; and

2. Compliance Officer/Compliance Committee

Bob is a partner in Rivkin Radler’s Compliance, Investigations & White Collar and Health Services practice groups.

A recent article in Part B News, “Be careful about upcoding; DOJ may come after it as a false claim,” discussed how the U.S. Department of Justice frequently prosecutes improper billing of CPT codes for Medicare patients. Rivkin Radler’s Jeff Kaiser was quoted in the article.

“Sometimes, a provider will upcode a…

The U.S. Department of Justice announced on February 27 that the University of Pittsburgh Medical Center (UPMC), James Luketich, its Chair of Cardiothoracic Surgery, and University of Pittsburgh Physicians have agreed to pay $8.5 million to settle a qui tam suit brought by a former UPMC cardiothoracic surgeon. The suit, brought under the False Claims…

On February 17, Daniel Russo, a Long Island resident, pleaded guilty in federal court in Brooklyn to multiple charges in connection with illegally distributing oxycodone. Russo faces decades in federal prison when he is sentenced.

Russo owned and operated Russo’s Pharmacy in Far Rockaway, Queens. From 2011 to 2014, he filled thousands of fraudulent prescriptions…

On the heels of publishing their final regulations, on January 31, the New York Office of the Medicaid Inspector General (OMIG) released a variety of guidance documents addressing compliance programs; self-disclosure; and Medicaid managed care fraud, waste and abuse prevention programs. The guidance documents can be found at:

Provider Compliance Programs

Self-Disclosure Program

Medicaid Managed…

In the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler’s Bob Hussar, Ashley Algazi and Mary Connolly will present “OMIG’s FINALIZED Regulations: What You Need to Do – NOW!”

On December 28, the Office of Medicaid Inspector General (OMIG) released their final compliance and self-disclosure regulations. The regulations implement 2020…