Fraud and Abuse

The U.S. Department of Justice (DOJ) announced on November 16 that two pharmacy owners from Forest Hills, New York have pleaded guilty to conspiracy to commit money laundering through submission of fraudulent claims to Medicare during the COVID-19 pandemic. The co-conspirators owned over a dozen pharmacies in the New York area, through which they submitted…

Rivkin Radler’s Michael Sirignano authored an article for the November 3 issue of the New York Law Journal entitled “The Triple Threat of Workers’ Compensation Fraud.” Although the article wasn’t in time for Rivkin Rounds’ recent Fraud Week, it discussed some recent attempts by healthcare providers to game the workers’ comp system by…

Federal and state enforcement activity involving pharmacy fraud tops the list of categories in this edition of Rivkin Rounds’ Fraud Week. We’ll list just a sampling of cases.

On October 19, the U.S. Department of Justice (DOJ) announced that Jerry May Keepers of Kingswood, Texas was sentenced to 36 months of supervised probation for writing…

Home health-related fraud and dentists behaving badly (see this week’s earlier posts) have both been notable recent trends, but the U.S. Department of Justice (DOJ) has been even busier lately cracking down on fraud involving durable medical equipment. Most recently, on October 25, DOJ announced that Daniel Canchola of Flower Mound, Texas pleaded guilty to…

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’…