Your prescribed dose of health law news
On May 28, the U.S. Department of Health and Human Services (HHS) finalized regulations intended to make the Independent Dispute Resolution (IDR) process under the No Surprises Act (NSA) more efficient and transparent in helping to resolve out-of-network payment disputes between healthcare providers and payors.
Under the IDR process, insurers and healthcare providers both file…
Aspen Dental, one of the nation’s largest dental service organizations (DSOs), recently settled charges alleging violations of California’s corporate practice of medicine (CPOM) and unfair competition laws. This was not the first time similar charges had been lodged against Aspen Dental; in 2015, it entered into a settlement with the New York Attorney General after…
On May 27, in furtherance of the March 16, 2026 Executive Order on Eliminating Fraud, Assistant Attorney General Brett A. Shumate issued a memo titled “Accelerating Review and Enhancing Enforcement in Benefits Fraud Matters.” The Memo announced new measures by the U.S. Department of Justice (DOJ) to strengthen False Claims Act (FCA) enforcement…
The U.S. Department of Justice (DOJ) recently announced a new initiative to enhance its working relationship with data miners who bring cases as whistleblowers under the False Claims Act (FCA). The initiative is dubbed “FOCUS,” an acronym for Fraud Oversight through Careful Use of Statistics.
There has been a sharp increase in qui tam complaints…
[Note: On May 28, HHS finalized new regulations on the IDR process, as discussed here.]
The No Surprises Act (NSA), enacted in 2020, was designed to protect patients from unexpected medical bills in certain healthcare settings. The law primarily applies when a patient receives emergency care at either an in-network or out-of-network facility, or…
Adam Brosius, a former pharmacy executive, was recently sentenced to 24 months in prison and ordered to pay $33 million in restitution and $27 million in forfeiture.
Brosius was the director and then the president of Main Avenue Pharmacy, a mail-order pharmacy based in Clifton, New Jersey. He orchestrated a complex kickback scheme in which…
On March 26, the U.S. Department of Justice (DOJ) and the U.S. Attorney’s Office for the Southern District of New York filed a civil antitrust lawsuit against The New York and Presbyterian Hospital (NYP). The Complaint alleges that NYP violated Section 1 of the Sherman Act by requiring restrictive anti-competitive language in its commercial contracts…
Last month, Pinnacle MultiCare Nursing and Rehabilitation Center (Pinnacle) filed a federal action to stop the U.S. Department of Health and Human Services (HHS) from recouping tens of millions of dollars in Medicare Part A payments made to Pinnacle during the COVID-19 pandemic. According to its Complaint, Pinnacle received a letter from…
When does marketing cross the line? Learn from recent cases and enforcement trends reshaping anti-kickback risk for companies and counsel. On April 2, from 2:00 PM to 3:00 PM, Rivkin Radler’s Jeff Kaiser will speak on the ABA Litigation Section webinar, “Marketing or Misconduct? Trends and Hot Topics on Anti-Kickback Enforcement.” To register, click here
On March 11, the U.S. Department of Justice and U.S. Attorney’s Office announced that Aetna, a national health insurer, has agreed to pay $117,700,000 to settle alleged violations of the False Claims Act (FCA). The government was investigating Aetna for submitting inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan beneficiaries, which increased Aetna’s…
