Fraud and Abuse

The U.S. Department of Justice (DOJ) announced on October 18 that Oklahoma-based Carter Healthcare LLC and its affiliates, plus two executives, agreed to pay a total of over $30 million to resolve two separate qui tam cases. One lawsuit claimed that Carter paid remuneration to physicians in Oklahoma and Texas to induce referrals of Medicare…

The U.S. Attorney for the District of New Jersey and New York Attorney General Letitia James both announced on October 6 that pediatric dentist Barry L. Jacobson, his management company, and 13 affiliated pediatric dentistry practices agreed to pay $753,457 to resolve allegations of False Claims Act violations. Between 2011 and 2018, Jacobson and other…

On September 15, Deputy Attorney General (“DAG”) Lisa Monaco delivered remarks announcing updated guidance on how the Department of Justice will be prioritizing and prosecuting corporate crime.  Her remarks were accompanied by a formal memo, titled “Further Revisions to Corporate Criminal Enforcement Policies Following Discussions with Corporate Crime Advisory Group” (https://www.justice.gov/opa/speech/file/1535301/download).  However inelegant…

In the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Bob Hussar will discuss Overpayments and Self-Disclosures. Bob is a partner in Rivkin Radler’s Compliance, Investigations & White Collar and Health Services practice groups. The program will cover:

• Identifying whether you have an overpayment or potential fraud liability
• Determining when

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Rivkin Radler’s Jeff Kaiser will be a panelist at the Upstate New York Health Care Fraud Symposium hosted by the United States Attorney’s Office for the Northern District of New York. Jeff’s panel is entitled “Use of the False Claims Act in Health Care Fraud Investigations and Litigation.”

The symposium will take place on Friday,…

Rivkin Radler’s Michael Sirignano authored an article for the September 2 issue of the New York Law Journal entitled “As Telemedicine Expands, Insurance Fraud Grows.” The article discussed recent enforcement actions by the U.S. Department of Justice and the recent Special Fraud Alert issued by the U.S. Department of Health and Human Services’…

On August 23, the U.S. Department of Justice announced that Dallas-based optical lens manufacturer Essilor International and its affiliates agreed to pay $16.4 million to settle alleged violations of the federal Anti-Kickback Statute (AKS). Three former Essilor district sales managers filed a whistleblower suit under the False Claims Act claiming that between 2011 and 2016,…

If our most recent Fraud Week post (NY Chiropractor Billed for Non-Existent Acupuncture Services) didn’t already drive home the point, it is worth emphasizing that billing insurers for items or services that weren’t actually provided is always a bad idea.

On August 4, the U.S. Department of Justice (DOJ) announced that Ariel Madero…

The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently issued an Advisory Opinion on offering gift cards to patients for completing an online patient education program.

In this particular case, the online program was used to educate patients on the risks, benefits and expectations relating to surgeries, and it was…

On August 15, the U.S. Department of Justice (DOJ) announced that a Long Island chiropractor pleaded guilty to healthcare fraud for billing a private insurance company over $1 million for acupuncture services that were never performed. The investigation of Peter Adamczak was a joint effort by DOJ, the New York State Inspector General, and the…