Fraud and Abuse

On July 20, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) issued a Special Fraud Alert to caution healthcare practitioners who may wish to enter into arrangements with telehealth companies. The Alert describes several types of fraud schemes that have resulted in federal investigations and civil and/or criminal charges, particularly…

On July 13, the New York Office of Medicaid Inspector General (OMIG) published proposed regulations implementing 2020 changes to law relating to provider compliance programs, Medicaid managed care fraud, waste and abuse prevention programs, and OMIG’s self-disclosure program. The proposed changes will significantly affect both payers and providers alike.

In the next installment of Rivkin…

Rivkin Radler’s Michael Sirignano authored a recent article for the New York Law Journal entitled “The Anti-Kickback Statute’s Role in Health Insurance Fraud Cases.” The article discussed recent lawsuits against physicians, laboratories, hospitals, and a large pharmaceutical company, McKesson Corporation, under the False Claims Act and federal Anti-Kickback Statute.

On May 27, the U.S. District Court for the Northern District of California refused to dismiss a lawsuit[1] brought against Envision Healthcare Corp. alleging violations of California’s corporate practice of medicine (CPOM) prohibition, as well as state fee-splitting and kickback prohibitions. The action was brought by the American Academy of Emergency Medicine Physician Group…

In a recent Advisory Opinion, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) determined that an arrangement involving certain physicians who have an ownership interest in a medical device company that manufactures products that may be ordered by the physician owners (the “Company”) was not considered a suspect physician-owned…

With the proliferation of precision and individualized medicine, genetic testing and counseling will likely remain on the radar of the Department of Health and Human Services’ Office of Inspector General (OIG) and the Department of Justice for years to come. Biopharma companies and manufacturers must carefully consider the facts and safeguards applicable to any sponsored…

The increased use of telehealth services is a trend that is expected to continue long after the COVID-19 pandemic ends. In keeping with this trend, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently issued a favorable Advisory Opinion that allowed a federally qualified health center (FQHC) to provide free…

A New York woman was sentenced last month to 78 months in prison for defrauding healthcare programs, including obtaining more than $6.5 million from Medicare Part D plans and Medicaid drug plans.

Queens resident Aleah Mohammed owned five pharmacies, four of which operated under variations of the name “Superdrugs.” Between 2015 and 2020, the pharmacies…

On April 20, the U.S. Department of Justice (DOJ) announced criminal charges against 21 people across the country for COVID-19-related frauds. The defendants are accused of over $149 million in false billings to federal programs and thefts from federally funded pandemic assistance programs.

Some of the defendants, in California, New York and Maryland, allegedly obtained…

The U.S. Department of Justice (DOJ) recently intervened in an action filed in Texas against two laboratory CEOs, one hospital CEO, and numerous other executives, employees, and recruiters, seeking civil penalties and treble damages for violations of the False Claims Act. The DOJ’s complaint, which was unsealed on April 4, also alleges that the fraudulent…