Medicare and Medicaid

On December 19, Michael Lonski, a Greenwich psychologist, was sentenced to a 27-month prison term and three more years of supervised release for a scheme to defraud Medicaid. Lonski submitted over 80,000 claims from 2014 to 2019, and in calendar year 2017 he submitted claims for services on all but one day—including holidays and weekends.

The U.S. Department of Justice recently announced that Silver Lake Hospital, a long-term care hospital in Newark, New Jersey, and some of its investors agreed to pay $30.6 million to settle claims that they violated the False Claims Act (FCA) and the Federal Debt Collection Procedures Act (FDCPA). The hospital allegedly overbilled Medicare by claiming…

A recent Advisory Opinion (No. 23-15) from the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) concluded that a healthcare consulting company’s plan to offer gift cards to physician practices in exchange for referring potential new customers to the company does not violate the federal Anti-Kickback Statute (AKS).

The consulting company…

On Thursday, January 25, in the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler partner Bob Hussar will present “Top Ten Activities to Jump Start Your Compliance Program in the New Year.”  The program will take place from 12:00 noon to 1:00 PM Eastern time via Zoom.

Participants will be…

Community Health Network, Inc., based in Indianapolis, Indiana, has paid $345 million to settle alleged violations of the False Claims Act (FCA). The lawsuit was initiated through a whistleblower complaint that was filed in 2014 by the network’s former Chief Financial Officer. The suit alleged that, between 2008 and 2009, the network recruited hundreds of…

On December 14, the U.S. Attorney’s Office for the Southern District of New York and other agencies announced the indictment of Niranjan Mittal, a Brooklyn cardiologist, on multiple fraud charges. Mittal allegedly fabricated patient records, paid physicians for patient referrals, and billed for medically unnecessary procedures. The U.S. Attorney’s Office also filed a civil fraud…

A new rule will require nursing homes enrolled in Medicare or Medicaid to make disclosures about certain facility ownership, management and other operational information. The U.S. Department of Health and Human Services (HHS) published the rule on November 17, with lawmakers emphasizing that greater transparency in the operation and ownership of nursing homes will improve…

The 2024 Medicare Physician Fee Schedule final rule, released by the Centers for Medicare & Medicaid Services (CMS) earlier this month, extended certain telehealth-related flexibilities that were implemented during the early days of the COVID-19 pandemic. CMS issued a Fact Sheet summarizing the telehealth updates, as well as other important Medicare policy changes.

Until 2020…