The U.S. Department of Justice (DOJ) announced that Flower Mound Hospital Partners LLC, a partially physician-owned hospital in Flower Mound, Texas, agreed to pay $18.2 million to settle its alleged violations of the False Claims Act (FCA). The DOJ alleged that the hospital knowingly violated the FCA by submitting claims to Medicaid, Medicare, and TRICARE
NJ Pathology Practice Settles Alleged FCA Violations for $2.4 Million
On December 7, the U.S. Department of Justice (DOJ) announced that it had reached a Settlement Agreement with Princeton Pathology Services P.A., a New Jersey pathology practice, regarding Princeton Pathology’s alleged violations of the False Claims Act (FCA).
The DOJ contended that, from 2015 to 2020, Princeton Pathology submitted claims to Medicare under CPT code
Second Circuit: Disclosures Made Only to the Government are not “Public Disclosures” Triggering the Public Disclosure Bar
The Second Circuit, in United States ex rel. Foreman v. AECOM, No. 20-2756-cv, 2021 WL 5406437 (2d Cir. Nov. 19, 2021), addressed a question it had not previously decided, namely, whether disclosures made solely to the government are “public disclosures” sufficient to trigger the public disclosure bar under the False Claims Act (FCA).
The public
New FCA Amendments Pass Judiciary Committee and Advance to Floor Vote
On October 28, the Senate Committee on the Judiciary approved for consideration by the full Senate the False Claims Amendments Act of 2021 (“FCA-2021”). The primary sponsor of the bill (S. 2428) is Sen. Chuck Grassley (R-IA), and there are four cosponsors: Sen. Richard Durban (D-IL), Sen. John Kennedy (R-LA), Sen. Patrick Leahy (D-VT) and
Recent Developments in Telehealth: For the Pandemic and Beyond
On Thursday, November 18, in the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler Partner Eric D. Fader will present an overview of changes in the provision of telehealth services, and federal and state regulation of them, since the beginning of the COVID-19 pandemic. New rules and waivers that are
OIG Approves Hospital “Warranty” on Joint Replacement Procedures
The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently issued a favorable Advisory Opinion on an arrangement that would allow a hospital to offer free items and services to patients who experienced certain complications after undergoing joint replacement procedures at the hospital. The arrangement only applied to a specific list
DOJ Charges 138 with $1.4B in Telehealth Fraud, Other Schemes
On September 17, the U.S. Department of Justice (DOJ) announced criminal charges against 138 defendants for alleged healthcare fraud schemes that resulted in $1.4 billion in losses. Those charged included 23 doctors, 19 nurses and other licensed professionals, and 96 laypeople, in 31 federal districts across the U.S.
Telehealth-related fraud accounted for about $1.1 billion
OIG Issues Favorable Advisory Opinion on Arrangement between Medigap Plan and Hospital Network
On August 16, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) issued a favorable Advisory Opinion regarding an arrangement between a Medicare Supplemental Health Insurance (“Medigap”) plan and a preferred hospital organization (PHO). The arrangement in question incentivized Medigap policyholders to seek inpatient care from hospitals that participated in the
Compounding the Fraud: Questionable Billing by Pharmacies
Rivkin Radler partners Evan Krinick and Michael Sirignano authored an article, “Compounding the Fraud: Questionable Billing by Pharmacies,” in the July 6 issue of the New York Law Journal. The article discussed the U.S. Department of Justice’s continued concern over fraudulent claims for reimbursement to federal healthcare programs for compounded prescription drugs.
Sham Speaker Fees Lead to Jail Term
On June 16, Jeffrey Goldstein, a former Manhattan physician, was sentenced to 57 months in prison for taking $196,000 in kickbacks from Insys Therapeutics, a defunct Arizona-based opioid manufacturer. Goldstein pled guilty to conspiracy in 2019 for accepting purported “speaker fees” from Insys in 2013-15 to prescribe the company’s fentanyl spray, Subsys.
Goldstein was one