Fraud and Abuse

In October, two medical transportation companies were charged with or indicted for fraud in New York.   

The owner of Pearl Transit Corp. (“Pearl”), Jael Watts, was accused of running a sham transportation service that supposedly provided rides for persons with disabilities and seniors in Westchester, Putnam, Rockland, and Suffolk counties. In 2024, the…

The New York Office of the Medicaid Inspector General (OMIG) publishes audit protocols to “assist the Medicaid provider community in developing programs to evaluate compliance with Medicaid requirements under federal and state statutory and regulatory law.”1 Such protocols are “applied to a specific provider type or category of service in the course of an…

The U.S. Attorney’s Office for the Southern District of New York announced on August 21 that Niranjan Mittal, a Brooklyn-based cardiologist, was sentenced to 37 months in federal prison. Mittal pleaded guilty to violating the federal Anti-Kickback Statute (AKS) in connection with a fraudulent scheme that lasted roughly seven years and resulted in over $40…

The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) has issued a favorable Advisory Opinion for a non-profit foundation receiving donations from an affiliated company. The company in this case offers family-based therapy for children with a redacted “Disorder” (presumably autism), where the goal of the therapy sessions is to train…

New York’s Consumer Directed Personal Assistance Program (CDPAP) has long been the subject of enforcement at the New York State Attorney General’s Office (AG). Many of those enforcement actions involve caregivers who billed Medicaid for CDPAP services never provided but sometimes also implicate agencies that are responsible for processing caregiver payments and protecting against fraud.…

The federal government has demonstrated that it is more than willing to use the United States criminal code to prosecute home care agencies that pay unlawful financial inducements to generate referrals in violation of the Anti-Kickback Statute (AKS).

In a superseding indictment unsealed in March 2025, the United States Attorney’s Office for the Eastern District…

An article in the August issue of Healthcare Risk Management, “DOJ Targeting Healthcare for False Claims Act Enforcement,” discussed recent enforcement activity by the U.S. Department of Justice (DOJ) under the False Claims Act (FCA). Rivkin Radler’s Jeff Kaiser was quoted in the article.

Jeff predicted that the FCA will continue to…

The epidemic of out-of-control generative artificial intelligence in litigation filings has metastasized to a False Claims Act (FCA) lawsuit against a group of Utah anesthesiologists. On July 25, Mountain West Anesthesia, LLC and individual defendants in the case moved to bar the testimony of a medical billing expert whose report was riddled with AI-generated errors…

The owner of Sublime Medical Transportation in Schenectady County, New York was recently sentenced to three to nine years in state prison for orchestrating a large Medicaid fraud scheme. Muhammed Adnan Saeed netted over $700,000, along with more than $60,000 in unemployment benefits to which he was not entitled.

Between 2019 and 2023, Saeed routinely…

On July 2, the U.S. Department of Justice (DOJ) and Department of Health and Human Services (HHS) announced the formation of the DOJ-HHS False Claims Act Working Group to strengthen “their ongoing collaboration to advance priority enforcement areas” in combating healthcare fraud. The two agencies cited the long history of partnership between them in enforcing…