Your prescribed dose of health law news
[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…
Earlier this month, the New York Department of State (DOS) published a warning to consumers following an extensive investigation of so-called “med spas.” The DOS’s Division of Licensing led the investigation, in which 223 businesses were inspected.
The publication initially addressed the need for businesses that hold themselves out to the public as med spas…
A New York physician was recently sentenced in federal court for receiving kickbacks in exchange for ordering medically unnecessary brain scans. Vishnudat Seodat of Mattituck had practiced for 36 years and operated three “New York Health” offices on Long Island. He announced his retirement in a letter to patients last month.
From 2013 to 2019…
The U.S. Department of Justice recently announced a settlement with Patients Choice Laboratories (“PCL”), a diagnostic laboratory headquartered in Indianapolis, Indiana, under which PCL will pay over $9.6 million to resolve allegations that it violated the federal False Claims Act (FCA) and Anti-Kickback Statute (AKS). The government alleged that the lab knowingly submitted claims to…
Westside Behavioral Care Inc., a Colorado mental health clinic, recently sued Kaiser Foundation Health Plan of Colorado for prematurely terminating its participation agreement. Kaiser terminated the agreement in an effort to increase the provision of services through a less costly telehealth model.
The clinic is alleging that the early termination disrupted care for more than…
