Medicare and Medicaid

To celebrate the opening of Rivkin Radler’s first Florida office, we’ll cover some recent Florida frauds. The U.S. Department of Justice (DOJ) announced on April 20 that two Miami residents, Dean Zusmer and Lawrence Alexander, were sentenced to prison for their roles in a Medicare fraud scheme. Zusmer, a chiropractor, and Alexander, an orthopedic surgeon…

The U.S. Department of Justice (DOJ) announced on April 20 that it has brought criminal charges against 18 defendants across the U.S. for various fraud schemes related to the COVID-19 pandemic. The DOJ seized more than $16 million in cash and other proceeds from the schemes, which resulted in more than $490 million in false…

On the heels of New York’s Office of the Medicaid Inspector General (OMIG) releasing updated compliance requirements, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) announced today that it will also be updating and modifying its voluntary compliance guidance documents.

The OIG’s stated purpose for the modifications is to improve…

In the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler’s Bob Hussar will discuss the third and fourth required elements of an Effective Compliance Program:

  • Training
  • Effective lines of communication

Bob is a partner in Rivkin Radler’s Compliance, Investigations & White Collar and Health Services practice groups. The program will…

The U.S. Department of Justice (DOJ) recently announced a settlement with a Missouri neurosurgeon and his fiancée regarding alleged violations of the False Claims Act (FCA) and Anti-Kickback Statute (AKS). The parties agreed to pay $825,000 to settle the case.

The neurosurgeon and his fiancée were accused of receiving impermissible kickbacks from spinal implant companies…

An article in the March 20 issue of the Report on Medicare Compliance, “New NYS Compliance-Program Requirements May Be Useful Everywhere as a ‘Fresh Look,’” discussed the final compliance and self-disclosure regulations released by the New York Office of Medicaid Inspector General (OMIG) on December 28. Rivkin Radler’s Bob Hussar was quoted in…

An audit by the New Jersey Office of the State Comptroller (OSC) found that John Gore, a licensed drug and alcohol counselor, improperly billed and received over $1 million in Medicaid payments for services provided between 2016 and 2020. Gore will be required to repay the sum of $1,160,371. 

Significantly, Gore billed for clinical level…

Rivkin Radler’s Michael Sirignano authored an article for the March 2 issue of the New York Law Journal entitled “Healthcare Fraud Tops DOJ’s Annual False Claims Act Report – Again!” The article discussed a report issued by the U.S. Department of Justice detailing the settlements and judgments it obtained under the federal False…

In the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler’s Bob Hussar will discuss the first two required elements of an Effective Compliance Program:

1. Policies and Procedures; and

2. Compliance Officer/Compliance Committee

Bob is a partner in Rivkin Radler’s Compliance, Investigations & White Collar and Health Services practice groups.

A recent article in Part B News, “Be careful about upcoding; DOJ may come after it as a false claim,” discussed how the U.S. Department of Justice frequently prosecutes improper billing of CPT codes for Medicare patients. Rivkin Radler’s Jeff Kaiser was quoted in the article.

“Sometimes, a provider will upcode a…