Home health-related fraud and dentists behaving badly (see this week’s earlier posts) have both been notable recent trends, but the U.S. Department of Justice (DOJ) has been even busier lately cracking down on fraud involving durable medical equipment. Most recently, on October 25, DOJ announced that Daniel Canchola of Flower Mound, Texas pleaded guilty to
Medicare and Medicaid
Fraud Week: Kickbacks for Home Healthcare Referrals
By Eric Fader on
The U.S. Department of Justice (DOJ) announced on October 18 that Oklahoma-based Carter Healthcare LLC and its affiliates, plus two executives, agreed to pay a total of over $30 million to resolve two separate qui tam cases. One lawsuit claimed that Carter paid remuneration to physicians in Oklahoma and Texas to induce referrals of Medicare…
Fraud Week: Medically Unnecessary Pediatric Root Canals
By Eric Fader on
The U.S. Attorney for the District of New Jersey and New York Attorney General Letitia James both announced on October 6 that pediatric dentist Barry L. Jacobson, his management company, and 13 affiliated pediatric dentistry practices agreed to pay $753,457 to resolve allegations of False Claims Act violations. Between 2011 and 2018, Jacobson and other…
HHS Extends COVID-19 PHE Again
By Eric Fader on
On October 13, U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra formally renewed the federal COVID-19 public health emergency (PHE) for another 90 days. The PHE, which originally went into effect on January 31, 2020, provides important flexibilities for healthcare providers, including expanding the types of telehealth services that are reimbursable for
…
Overpayments and Self-Disclosures
In the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Bob Hussar will discuss Overpayments and Self-Disclosures. Bob is a partner in Rivkin Radler’s Compliance, Investigations & White Collar and Health Services practice groups. The program will cover:
• Identifying whether you have an overpayment or potential fraud liability
• Determining when
…
Dental Orgs Urge CMS to Expand Access to ASCs
By Sean Simensky on
On September 13, a coalition of leading dental organizations sent a letter to the Centers for Medicare & Medicaid Services (CMS) urging CMS to increase access to dental surgeries in ambulatory surgical centers (ASCs). The letter was signed by the American Academy of Pediatric Dentistry, American Dental Association, and American Association of Oral and Maxillofacial…
As Telemedicine Expands, Insurance Fraud Grows
By Rivkin Rounds Staff on
Rivkin Radler’s Michael Sirignano authored an article for the September 2 issue of the New York Law Journal entitled “As Telemedicine Expands, Insurance Fraud Grows.” The article discussed recent enforcement actions by the U.S. Department of Justice and the recent Special Fraud Alert issued by the U.S. Department of Health and Human Services’…
Fraud Week: Optical Lens Maker Reaches Kickback Settlement
By Eric Fader on
On August 23, the U.S. Department of Justice announced that Dallas-based optical lens manufacturer Essilor International and its affiliates agreed to pay $16.4 million to settle alleged violations of the federal Anti-Kickback Statute (AKS). Three former Essilor district sales managers filed a whistleblower suit under the False Claims Act claiming that between 2011 and 2016,…
Fraud Week: More Non-Existent Services
If our most recent Fraud Week post (NY Chiropractor Billed for Non-Existent Acupuncture Services) didn’t already drive home the point, it is worth emphasizing that billing insurers for items or services that weren’t actually provided is always a bad idea.
On August 4, the U.S. Department of Justice (DOJ) announced that Ariel Madero…
OIG Concludes that $25 Patient Gift Card Presents Low Risk of Fraud and Abuse
By Ada Janocinska on
The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently issued an Advisory Opinion on offering gift cards to patients for completing an online patient education program.
In this particular case, the online program was used to educate patients on the risks, benefits and expectations relating to surgeries, and it was…