Medicare and Medicaid

Earlier this month, an owner of Brooklyn-based Happy Family Social Adult Day Care Center, Inc., Family Social Adult Day Care Center, Inc. and Responsible Care Staffing, Inc., a home health care fiscal intermediary operating under the Consumer Directed Personal Assistance Program (CDPAP), pleaded guilty to defrauding Medicaid of approximately $65 million for social adult day…

An article in the September 17 issue of Part B News, “Medicare exclusions not just for OIG anymore: RFK Jr.,” discussed various types of possible disciplinary actions against Medicare providers. Rivkin Radler’s Chris Kutner was quoted in the article.

“I don’t think there’s a percentage of the population that really understands the…

Two Long Island ophthalmology practices have agreed to return $2.3 million in payments from state and federal government programs based on the ordering of unnecessary trans-cranial doppler ultrasounds (TCDs). The lawsuit brought by a whistleblower under the False Claims Act (FCA) against Mark D. Fromer, P.C., dba Fromer Eye Centers, and Floral Park Ophthalmology P.C.

New York Medicaid providers should prepare now for significant changes in provider enrollment oversight. The New York State Department of Health (DOH), following direction from the Centers for Medicare & Medicaid Services (CMS), will require every Medicaid-enrolled provider in New York to complete revalidation over the next 24 months. The process will require coordination among…

With the New York Medicaid Program facing scrutiny by the U.S. Department of Health and Human Services (HHS) for a perceived lack of oversight and compliance integrity involving certain types of providers (including personal care and home health providers), the New York Department of Health (DOH) recently announced certain program administrative measures that seem designed…

The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently issued Advisory Opinion 26-16, concluding that the “food-as-medicine” program operated by a federally qualified health center, which provides weekly produce boxes or vouchers paired with periodic health assessments for financially needy patients with diabetes or hypertension, presents a low risk…

On July 1, 2026, the Centers for Medicare & Medicaid Services (CMS) proposed a new rule that included certain enrollment-related policy changes under the Home Health Prospective Payment System (HHPPS) designed to “reduce improper Medicare payments and protect beneficiaries.”[1]

As explained by CMS, “[t]he overarching purpose of the enrollment process is to help confirm…

Two New York residents were recently indicted in the Eastern District of New York federal court in Central Islip for conspiracy to commit healthcare fraud, among other charges. The defendants allegedly paid kickbacks and submitted fraudulent claims to government payors, including Medicaid, for transportation services that were either not provided or for which the mileage…

On June 16, The Department of Justice (DOJ) sued the New York Department of Health (DOH), the DOH Medicaid Director, and Public Partnerships LLC (PPL) – the Georgia-based company selected by DOH in 2025 to manage New York’s Consumer Directed Personal Assistant Program (CDPAP) – in federal district court.  The lawsuit alleges that the defendants…