The owner of Brooklyn Chemists in Gravesend, Brooklyn and Lucky Care Pharmacy in Flushing, Queens was recently indicted on charges of conspiracy to commit health care fraud, conspiracy to defraud the United States by paying kickbacks and bribes in connection with the provision of health care services, and unlawfully spending the proceeds of the fraud.
Medicare and Medicaid
False Claims Act Cases Poised to Jump Now and for Years to Come
Rivkin Radler’s Evan H. Krinick wrote an article entitled “False Claims Act Cases Poised to Jump Now and for Years to Come” that was published in the March 5, 2021 issue of the New York Law Journal. The article discusses health insurance fraud cases in 2020 that involved kickbacks, provision of medically…
Provider Relief Fund Audits Coming
By Rivkin Rounds Staff on
A February 15 article in Part B News, “Provider Relief Fund audits coming; pick your method and keep good records,” discussed the Provider Relief Fund (PRF) authorized under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Rivkin Radler’s Bob Iseman was quoted in the article.
Healthcare providers who received PRF…
California Laboratory Settles FCA Claims Related to Genetic Testing
By Rivkin Rounds Staff on
Exceltox Laboratories, LLC, a California diagnostic laboratory, is paying a $357,584 settlement to resolve allegations of False Claims Act (FCA) violations. Exceltox allegedly submitted or caused to be submitted claims for genetic tests to Medicare without valid physician oversight.
In 2015, Exceltox engaged an independent contractor, Seth Rehfuss, who persuaded residents of low-income senior housing…
Two Indicted in $100 Million Home Health Care Fraud Scheme
By Eric Fader on
The U.S. Department of Justice (DOJ) announced on February 1 that an owner and operator of Arbor Homecare Services LLC and a nurse employed by the home health agency were indicted for their roles in a scheme to defraud MassHealth and Medicare of at least $100 million. The Massachusetts agency allegedly routinely billed the government…
EHR Vendor to Pay $18.25 Million to Resolve Kickback Allegations
By Eric Fader on
The U.S. Department of Justice (DOJ) announced on January 28 that athenahealth Inc., a Massachusetts-based electronic health records (EHR) technology vendor, has agreed to pay $18.25 million to resolve allegations that it paid illegal kickbacks to generate sales of its EHR product, athenaClinicals. The settlement is the government’s latest reminder that marketing initiatives that are…
CMS Clarifies RPM Reimbursement
The Centers for Medicare & Medicaid Services (CMS) recently released corrections to its 2021 Physician Fee Schedule final rule that was published on December 28. Some of the corrections clarify reimbursement requirements for remote patient monitoring (RPM), which entails gathering and interpreting physiologic data from patients at home.
The December 28 final rule had stated…
HHS Rule Blocks Enforcement Actions Based Solely on Guidance
By Eric Fader on
On January 12, the U.S. Department of Health and Human Services (HHS) released a final rule on “Transparency and Fairness in Civil Administrative Enforcement Actions.” The rule, which was effective immediately, states that HHS can rely only on statutes and regulations in bringing civil enforcement actions. Standards set forth in agency guidance documents…
NY Gov. Cuomo Proposes Expanded Telehealth Access
By Eric Fader on
In his 2021 State of the State Address on January 10, New York Governor Andrew Cuomo announced legislation to expand access to telehealth. The proposals will adjust reimbursement incentives to encourage telehealth, relax or eliminate outdated regulatory restrictions on the delivery of telehealth services, and establish training programs for patients and providers and other programs…