The 12 regional Medicare Administrative Contractors (MACs) were recently audited by the U.S. Department of Health and Human Services’ Office of Inspector General (OIG). Each of the MAC jurisdictions was found by the OIG to have failed to meet Medicare cost report oversight requirements in at least one year during the 2019-2021 fiscal years under
Medicare and Medicaid
Lab Co-Owners Acquitted in Alleged COVID-19 Testing Scheme
By Rivkin Rounds Staff on
A Florida jury recently found two laboratory co-owners of Innovative Genomics LLC (“IGX”) not guilty in connection with an allegedly fraudulent COVID-19 testing scheme.
The Government alleged that from November 2019 through June 2023, the co-owners conspired to defraud Medicare and the Health Resources and Services Administration COVID-19 Uninsured Program by billing healthcare benefit plans…
In trend, court limits drug rebate AKS charges to easier ‘but-for’ standard
By Rivkin Rounds Staff on
An article in the March 10 issue of Part B News, “In trend, court limits drug rebate AKS charges to easier ‘but-for’ standard,” discussed a recent ruling on the False Claims Act (FCA) implications of the federal Anti-Kickback Statute (AKS). Rivkin Radler’s Jeff Kaiser was quoted in the article.
“Every time a…
Lab Operator Convicted in Drug-Testing Scheme
By Chris Kutner on
Conspiracies to rip off the Medicare system are prevalent due to the vast amounts of money flowing through the program. On February 25, Sherif Khalil of Redondo Beach, California man was convicted by a federal jury in Detroit for stealing $4 million from the Medicare program.
Khalil conspired with others to generate orders for medically…
Provider and Beneficiaries Conspired to Defraud Louisiana’s Medicaid Program
By Chris Kutner on
Healthcare fraud is prevalent within state Medicaid programs due to the massive amounts of money flowing through the system. In Louisiana, the Estate of Yolanda Burnom and her former company, Community Healthcare Solutions, LLC, recently agreed to pay $4.6 million to settle a False Claims Act lawsuit.
The allegations included providing incentives to Medicaid beneficiaries…
Online DME Company Billed Insurers for Unnecessary Medical Supplies
By Chris Kutner on
DMERx, an online DME platform, served as the basis for a massive fraud against Medicare and other insurers. Gregory Schreck, a Kansas man who was the vice president of DMERx, orchestrated a sophisticated fraud scheme to bill Medicare and other insurers over $1 billion, resulting in payments of over $350 million. The scheme used DMERx’s…
NYS OMIG Publishes 2025 Work Plan
On January 29, the New York State Office of the Medicaid Inspector General (OMIG) published its 2025 Work Plan, which provides a preview of the OMIG’s program integrity initiatives for the upcoming year. While this post highlights several areas that the OMIG will focus on, Medicaid providers should refer to the Work Plan for…
Hospital CEO Jailed for Conspiracy to Violate AKS
By Ada Janocinska on
The U.S. Department of Justice announced on January 15 that Jeffrey Paul Madison, the former chief executive officer of a Texas hospital, was sentenced to 36 months in federal prison for conspiring to violate the federal Anti-Kickback Statute (AKS). In October 2024, Madison also agreed to pay over $5.3 million to settle allegations under the…
FCA Delivers: Government Recovered $2.9 Billion in 2024
By Tim Gonzalez on
The U.S. Department of Justice (DOJ) recovered $2.9 billion under the False Claims Act (FCA) in 2024, a 5% bump from 2023. This total represents the most recovered since 2021 and reaffirms the FCA’s central role in the government’s anti-fraud efforts.
The DOJ entered 558 FCA settlements and judgments, the second highest total after 2023’s…
Some COVID-Era Medicare Telehealth Waivers Extended through March 31
By Eric Fader on
The American Relief Act, 2025, signed into law on December 21, included a short-term extension of certain telehealth waivers that went into effect in the early days of the COVID-19 Public Health Emergency. These waivers, for telehealth services provided to Medicare beneficiaries, had been set to expire on December 31, but have now been…