Medicare and Medicaid

On April 11, the medical director and the owner of a pain clinic in Kentucky were sentenced to prison for their roles in a scheme to defraud federal healthcare programs and commercial insurance companies for medically unnecessary urine drug testing. Previously, in March 2023, the clinic’s medical director, William Lawrence Siefert, was convicted of healthcare…

On April 10, Virginia-based nurse practitioner Daphne Jenkins was sentenced to prison for her participation in a $7.8 million telemedicine fraud scheme that involved medically unnecessary orders for durable medical equipment (DME). As part of the scheme, Medicare claims were submitted based on false documentation and tainted by kickbacks.  

The orders Jenkins signed were pre-populated…

On Thursday, April 11, in the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler’s Bob Hussar, Chris Kutner and Mary Aperance will present “Defending Provider Audits.”  The program will take place from 12:00 noon to 1:00 PM Eastern time via Zoom.

The program will cover the similarities and differences in…

On February 26, David Weathers of the Bronx pleaded guilty in federal court in New Jersey for his role in a COVID-19 kickback conspiracy. The government had charged Weathers with soliciting kickbacks in return for referrals of COVID-19 test samples, in violation of the federal Anti-Kickback Statute (AKS).

At the other end of the scheme…

The U.S. Attorney’s Office for the District of New Jersey recently announced a $750,000 settlement with Sentynl Therapeutics Inc., a California-based specialty pharmaceutical company. The settlement resolved allegations that Sentynl improperly provided kickbacks to a physician to induce prescriptions of its opioid products in violation of the federal Anti-Kickback Statute (AKS).

The Government alleged that…

A March 11 article in Part B News, “Warning: Minor Errors Can Mean Big Takebacks for AWV Claims,” discussed how compliance shortcomings can cause problems for claims to Medicare for annual wellness visits (AWVs). Rivkin Radler’s Mary Aperance was quoted in the article.

“Routine internal audits should be conducted to hone in…

On March 4, the New York Attorney General announced an $8.6 million settlement with Fulton Commons Care Center, a nursing home located in East Meadow, NY. The settlement resolves an action brought against Fulton in 2022 claiming financial fraud, physical abuse, mistreatment of residents, and covering up resident complaints.

The AG had previously sued the…

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…