Medicare and Medicaid

On June 24, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) announcedfinal rule that establishes disincentives for certain health care providers that have committed information blocking, or any activity that is likely to hamper access, exchange, or use of electronic protected health information (PHI). This rule

On June 27, U.S. Attorney General Merrick Garland announced the results of a two-week nationwide law enforcement action by the Department of Justice (DOJ) in 32 federal districts against 193 defendants for their participation in a variety of healthcare fraud schemes. These federal enforcement actions also included the seizure of more than $230 million in

Rivkin Radler Partner Eric Fader co-authored an article in the March-April issue of SpineLine, the magazine of the North American Spine Society (NASS). The article, “OIG Advisory Opinion Cautions Against ‘Surgeon Deals’ in Neuromonitoring,” was written with Rich Vogel, PhD, DABNM, FASNM, the current President of the American Society of Neurophysiological Monitoring

On May 16, the U.S. Attorney’s Office for the District of Massachusetts announced that Cape Cod Hospital agreed to pay $24.3 million to resolve alleged violations of the federal False Claims Act (FCA) for knowingly failing to follow Medicare’s requirements for certain procedures performed.

Beginning in 2015, the hospital offered transcatheter aortic valve replacement (TAVR)

Manishkumar Patel of Pelham Manor, NY recently pleaded guilty in connection with a healthcare fraud and kickback scheme involving the sale of fraudulent prescriptions to pharmacies, durable medical equipment suppliers, and laboratories, which then obtained payments from Medicare. The scheme resulted in $50 million in fraudulent claims from 2019-22.

Patel and a co-conspirator worked with

The U.S. Attorney’s Office for the Eastern District of Michigan announced on May 8 that Michigan Ear Care PLLC and James Aronovitz, D.O. agreed to pay over $2 million to resolve allegations that they submitted false claims to the Medicare and Medicaid programs.

Aronovitz allegedly billed for ear care services under his own National Provider

Robert Clark of Pompano Beach, Florida recently pleaded guilty to his role in a Medicare fraud scheme. Clark and his co-conspirators purchased Medicare Beneficiary Identification numbers unlawfully and then billed Medicare for over-the-counter COVID-19 test kits. The conspirators also paid illegal kickbacks and bribes to marketers for referring Medicare beneficiaries for genetic tests.

Approximately $30

On April 11, the medical director and the owner of a pain clinic in Kentucky were sentenced to prison for their roles in a scheme to defraud federal healthcare programs and commercial insurance companies for medically unnecessary urine drug testing. Previously, in March 2023, the clinic’s medical director, William Lawrence Siefert, was convicted of healthcare

On April 10, Virginia-based nurse practitioner Daphne Jenkins was sentenced to prison for her participation in a $7.8 million telemedicine fraud scheme that involved medically unnecessary orders for durable medical equipment (DME). As part of the scheme, Medicare claims were submitted based on false documentation and tainted by kickbacks.  

The orders Jenkins signed were pre-populated

On Thursday, April 11, in the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler’s Bob Hussar, Chris Kutner and Mary Aperance will present “Defending Provider Audits.”  The program will take place from 12:00 noon to 1:00 PM Eastern time via Zoom.

The program will cover the similarities and differences in