Medicare and Medicaid

The U.S. Department of Justice (DOJ) announced on March 3 that Ameet Goyal, M.D., a Westchester-based ophthalmologist, was sentenced to 96 months in prison for falsely billing for millions of dollars of upcoded procedures over seven years, and for fraudulently obtaining two business loans under the CARES Act’s Paycheck Protection Program (PPP) in the early…

Rivkin Radler’s Michael Sirignano wrote an article, “The Opioid Crisis: An Epidemic Exacerbated by Fraud,” that appeared in the March 3 issue of the New York Law Journal. The article discussed the various types of opioid fraud, including illegal distribution, fake prescriptions, illegal dispensing by pharmacies, and medically unnecessary procedures.

Sign up…

We don’t often cover brand-new proposed legislation on Rivkin Rounds, generally preferring to wait until it’s closer to becoming law. However, two bipartisan bills introduced in Congress last week are worthy of mention.

The Telehealth Extension and Evaluation Act would allow the Centers for Medicare & Medicaid Services to extend certain pandemic-era flexibilities in Medicare…

On Thursday, January 13, in the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler Partner Robert Hussar will present a review of key developments in healthcare fraud and abuse, compliance and government enforcement in 2021 as well as trends and changes in the industry that will impact healthcare organizations and…

Rivkin Radler’s Michael Sirignano wrote an article, “An Insurance Fraud Year in Review,” that was published in the January 6 issue of the New York Law Journal. Among the many cases and settlements discussed were False Claims Act cases involving federal healthcare programs, healthcare fraud related to COVID-19 testing and telehealth services,…

On January 7, the U.S. Supreme Court will hear oral arguments pursuant to emergency requests in two cases concerning COVID-19 mandates. One case involves a challenge by a coalition of interest groups and states opposed to the Occupational Safety and Health Administration’s mandate, which requires employees of businesses with 100 or more employees to receive…

Many of the changes to telehealth requirements during the COVID-19 pandemic on both the federal and state levels were intended to be temporary, as previously discussed here. Recently, a bipartisan group of lawmakers in Congress introduced the Telehealth Extension Act, which would, among other things, eliminate the requirement that patients live in a…

The U.S. Department of Justice (DOJ) announced that Flower Mound Hospital Partners LLC, a partially physician-owned hospital in Flower Mound, Texas, agreed to pay $18.2 million to settle its alleged violations of the False Claims Act (FCA). The DOJ alleged that the hospital knowingly violated the FCA by submitting claims to Medicaid, Medicare, and TRICARE…

On December 7, the U.S. Department of Justice (DOJ) announced that it had reached a Settlement Agreement with Princeton Pathology Services P.A., a New Jersey pathology practice, regarding Princeton Pathology’s alleged violations of the False Claims Act (FCA).

The DOJ contended that, from 2015 to 2020, Princeton Pathology submitted claims to Medicare under CPT code…

A study recently released by the U.S. Department of Health and Human Services (HHS) found that the number of beneficiaries in the traditional Medicare program who used telehealth increased from 840,000 in 2019 to nearly 52.7 million in 2020. At the same time, the number of visits to doctors’ offices reimbursed under Part B decreased.…