Your prescribed dose of health law news
The owner of Sublime Medical Transportation in Schenectady County, New York was recently sentenced to three to nine years in state prison for orchestrating a large Medicaid fraud scheme. Muhammed Adnan Saeed netted over $700,000, along with more than $60,000 in unemployment benefits to which he was not entitled.
Between 2019 and 2023, Saeed routinely…
Cigna filed a lawsuit on June 24 in Manhattan federal court accusing Bristol Myers Squibb of unlawfully blocking generic versions of its blood cancer drug, Pomalyst, from entering the market. The suit also names Celgene, a Bristol Myers subsidiary that originally developed and marketed the drug. Cigna alleges that Celgene violated U.S. antitrust laws by…
The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) has announced another settlement for alleged violations of HIPAA. OCR investigated BayCare Health System, which serves central Florida, after a patient complained to OCR in 2018 that her medical record was accessed by an unauthorized individual.
The patient told OCR that she…
The Nassau County District Attorney recently charged Joseph Golyan, a Great Neck gastroenterologist, with collecting Social Security and other government benefits over a four-year period, while simultaneously billing Medicare for care he was providing to Medicare beneficiaries. He allegedly collected over $100,000 in disability benefits, while billing Medicare over $700,000, during the relevant period. The…
Last month, the head of the Criminal Division of the U.S. Department of Justice (DOJ), Matthew R. Galeotti, issued a Memorandum outlining DOJ’s enforcement priorities and policies for prosecuting white-collar crime, identifying three core tenets to guide prosecutors: “(1) focus; (2) fairness; and (3) efficiency.”
Among the areas of focus listed, the Memorandum identified as…
Two Pennsylvania nursing home operators were recently sentenced in federal court to pay more than $15 million in restitution in a healthcare fraud case. Comprehensive Healthcare Management Services, the operator of Brighton Rehabilitation and Wellness Center, and the affiliated operator of Mount Lebanon Rehabilitation and Wellness Center were convicted of making false statements in connection…
Jeff Kaiser’s article, “COVID-19 Pandemic Fraud Enforcement Efforts Overview,” was published in the LexisNexis legal research tool, Practical Guidance.
In the article, Jeff offers a comprehensive overview of enforcement efforts related to COVID-19 pandemic fraud.
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The U.S. Court of Appeals for the Seventh Circuit recently rejected an effort by the federal government to extend the federal Anti-Kickback Statute (AKS) to a marketing company in the absence of influence by the company over decision makers.
Mark Sorensen, the owner of SyMed Inc., a durable medical equipment (DME) distributor, had been convicted…
On May 1, a whistleblower filed a complaint under the federal False Claims Act (FCA) against Aetna, Elevance Health (formerly Anthem) and Humana alleging that the insurers paid hundreds of millions of dollars in illegal kickbacks to induce brokers including GoHealth, eHealth and SelectQuote (the “Brokers”) to steer beneficiaries to their Medicare Advantage plans. While…
The U.S. Attorney’s Office for the Eastern District of Pennsylvania announced on April 23 that Genexe, LLC (doing business as Genexe Health) and its parent company, Immerge, Inc., along with two of their executive officers/owners, Jason Green and Jason Gross, collectively agreed to pay $6 million to settle claims that they violated the False Claims…
