Fraud and Abuse

The U.S Attorney’s Office for the District of Connecticut announced on May 9 that Yale New Haven Health Services Corp. and Northeast Medical Group, Inc. have paid $560,718.48 to resolve federal and state False Claims Act (FCA) allegations. The hospital system allegedly submitted claims to Medicare and Medicaid for services provided by mid-level providers…

In the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler’s Bob Hussar and Mary Aperance will discuss the fifth and sixth required elements of an Effective Compliance Program. They will discuss:

  • Disciplinary Standards
  • Auditing and Monitoring

Bob is a partner in Rivkin Radler’s Compliance, Investigations & White Collar and Health…

Here’s a selection of recent healthcare frauds from New Jersey. On April 17, John Sher of Margate was sentenced to 37 months in prison and ordered to pay $2.77 million in restitution and $327,987 in forfeiture for defrauding New Jersey state and local health benefits programs and other insurers. Sher and a co-conspirator recruited state…

Transportation fraud isn’t new, but it’s new to Rivkin Rounds. The U.S. Attorney’s Office for the Southern District of New York recently announced that Yonkers resident Julio Alvarado was sentenced to 95 months in prison for leading a scheme that billed Medicaid for fraudulent transportation claims. From 2017 to 2020, KJ Transportation C Services Inc.…

To celebrate the opening of Rivkin Radler’s first Florida office, we’ll cover some recent Florida frauds. The U.S. Department of Justice (DOJ) announced on April 20 that two Miami residents, Dean Zusmer and Lawrence Alexander, were sentenced to prison for their roles in a Medicare fraud scheme. Zusmer, a chiropractor, and Alexander, an orthopedic surgeon…

The U.S. Department of Justice (DOJ) announced on April 20 that it has brought criminal charges against 18 defendants across the U.S. for various fraud schemes related to the COVID-19 pandemic. The DOJ seized more than $16 million in cash and other proceeds from the schemes, which resulted in more than $490 million in false…

On the heels of New York’s Office of the Medicaid Inspector General (OMIG) releasing updated compliance requirements, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) announced today that it will also be updating and modifying its voluntary compliance guidance documents.

The OIG’s stated purpose for the modifications is to improve…

In the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler’s Bob Hussar will discuss the third and fourth required elements of an Effective Compliance Program:

  • Training
  • Effective lines of communication

Bob is a partner in Rivkin Radler’s Compliance, Investigations & White Collar and Health Services practice groups. The program will…

The U.S. Department of Justice (DOJ) recently announced a settlement with a Missouri neurosurgeon and his fiancée regarding alleged violations of the False Claims Act (FCA) and Anti-Kickback Statute (AKS). The parties agreed to pay $825,000 to settle the case.

The neurosurgeon and his fiancée were accused of receiving impermissible kickbacks from spinal implant companies…