Litigation

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…

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…

A law in New York Gov. Kathy Hochul’s proposed budget aimed at regulating “large physician practices being managed by entities that are investor-backed” has been dropped from the State Senate and Assembly proposed budgets (S4007B/A3007B).

Subject to final budget negotiations, the proposed law appears unlikely to be enacted in the immediate future. However, the proposal…

The Westchester District Attorney’s office announced on March 17 that it has charged Cesar Masso, a 78-year-old Queens resident, with illegally practicing dentistry without a license. Masso operated a dental practice in White Plains under the name East Post Dental, performing professional services including extractions, examinations, and delivering anesthetics, and has been charged with three…

Rivkin Radler’s Michael Sirignano authored an article for the March 2 issue of the New York Law Journal entitled “Healthcare Fraud Tops DOJ’s Annual False Claims Act Report – Again!” The article discussed a report issued by the U.S. Department of Justice detailing the settlements and judgments it obtained under the federal False…

A recent article in Part B News, “Be careful about upcoding; DOJ may come after it as a false claim,” discussed how the U.S. Department of Justice frequently prosecutes improper billing of CPT codes for Medicare patients. Rivkin Radler’s Jeff Kaiser was quoted in the article.

“Sometimes, a provider will upcode a…