Litigation

The U.S. Department of Justice (DOJ) announced on February 18 that Health Net Federal Services, LLC and its corporate parent, Centene Corporation, agreed to pay $11,253,400 to resolve False Claims Act (FCA) claims. Health Net, a federal contractor responsible for administering TRICARE, allegedly falsely certified compliance with cybersecurity requirements in its contract with the U.S.

DMERx, an online DME platform, served as the basis for a massive fraud against Medicare and other insurers. Gregory Schreck, a Kansas man who was the vice president of DMERx, orchestrated a sophisticated fraud scheme to bill Medicare and other insurers over $1 billion, resulting in payments of over $350 million. The scheme used DMERx’s…

The U.S. Department of Justice announced on January 15 that Jeffrey Paul Madison, the former chief executive officer of a Texas hospital, was sentenced to 36 months in federal prison for conspiring to violate the federal Anti-Kickback Statute (AKS). In October 2024, Madison also agreed to pay over $5.3 million to settle allegations under the…

The U.S. Department of Justice (DOJ) recovered $2.9 billion under the False Claims Act (FCA) in 2024, a 5% bump from 2023. This total represents the most recovered since 2021 and reaffirms the FCA’s central role in the government’s anti-fraud efforts.

The DOJ entered 558 FCA settlements and judgments, the second highest total after 2023’s…

The New York State Attorney General’s Office announced on December 5 that Muhammad Rizwan Khan, Muhammad Usman Khan and Farhan Khan and their Orange County-based transportation companies, Tristate Express NY, Inc., Meditrans NY Inc. and Empire Trans NY Inc., pleaded guilty to various felony grand larceny charges in connection with a fraudulent scheme that resulted…

Kenneth Fishberger, a Long Island internist with nearly 50 years of medical experience, recently pleaded guilty to conspiracy to commit healthcare fraud. Prosecutors revealed that from 2013 to 2019, Fishberger ordered hundreds of medically unnecessary transcranial doppler (TCD) brain scans in exchange for kickbacks.

In this scheme, Fishberger collaborated with a salesperson and a principal…

A November 25 article in Part B News, “Third-party biller fraud may hook your practice, unless you protect yourself,” discussed the federal government’s recent fraud investigation of a medical biller in New York State and healthcare providers’ obligation to ensure the accuracy of their claims billing. Rivkin Radler’s Jeff Kaiser was quoted…

On October 31, Elevance Health filed suit against the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) to challenge the 2025 Star Ratings system used for Medicare Advantage and Part D plans. CMS published the final Star Ratings to the public on October 10 through the…

One of the nation’s largest urine drug testing laboratories recently settled with the federal government by paying $27 million to resolve alleged violations of the federal False Claims Act (FCA) and state statutes. Precision Toxicology (d/b/a Precision Diagnostics), headquartered in San Diego, allegedly provided medically unnecessary urine drug testing and offered free items to physicians…

On October 9, 2024, the United States Attorney’s office in the Eastern District of New York unsealed an indictment alleging that eight defendants defrauded Medicaid of approximately $68 million.1 The alleged scheme involved two adult day care programs and a home care financial intermediary, all owned and controlled by the same individuals, as well…