On May 1, a whistleblower filed a complaint under the federal False Claims Act (FCA) against Aetna, Elevance Health (formerly Anthem) and Humana alleging that the insurers paid hundreds of millions of dollars in illegal kickbacks to induce brokers including GoHealth, eHealth and SelectQuote (the “Brokers”) to steer beneficiaries to their Medicare Advantage plans. While
Private Insurers
Elevance Health Sues HHS and CMS Over Star Ratings System
By Mary Aperance on
On October 31, Elevance Health filed suit against the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) to challenge the 2025 Star Ratings system used for Medicare Advantage and Part D plans. CMS published the final Star Ratings to the public on October 10 through the…
Fader Co-Authors Article, Presents Podcast on Neuromonitoring “Surgeon Deals”
Rivkin Radler Partner Eric Fader co-authored an article in the March-April issue of SpineLine, the magazine of the North American Spine Society (NASS). The article, “OIG Advisory Opinion Cautions Against ‘Surgeon Deals’ in Neuromonitoring,” was written with Rich Vogel, PhD, DABNM, FASNM, the current President of the American Society of Neurophysiological Monitoring…
Defending Provider Audits
By Rivkin Rounds Staff on
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…
Federal Rules Limit “Junk” Health Plans
By Ada Janocinska on
On March 28, the U.S. Departments of Health and Human Services, Labor and the Treasury collectively issued final rules with respect to short-term and limited duration insurance (STLDI) plans in an effort to reduce healthcare costs by protecting consumers from purchasing such “junk” health plans that may provide little to no coverage in many scenarios. …
NJ LCSW Pleads Guilty to Defrauding Private Health Insurers for Years
By Tim Gonzalez on
The owner of Bergen Alliance Counseling Services in Paramus, New Jersey pleaded guilty to a run-of-the-mill healthcare fraud scheme in District Court in Newark on March 19. Maria Cosentino of Garfield, a licensed clinical social worker, admitted to billing private healthcare programs for counseling sessions that did not take place.
The practice provided counseling services…
NY Man Jailed for 12 years for $600 Million Healthcare Fraud
By Chris Kutner on
A Long Island man who impersonated the general counsel of the NFL and an NBA player as part of his scheme for multiple frauds will now serve jail time. Sentenced in federal court in Central Islip, Matthew James used physicians throughout the country to bill health insurers fraudulently to the tune of hundreds of millions…
Telehealth After the Pandemic: Recent Federal and State Developments
On Thursday, September 14, in the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler partner Eric D. Fader will present an update on the regulatory landscape for the provision of telehealth services, including recent changes to federal and state laws and rules. The program will take place from 12:00 noon…
OIG Advisory Opinion Warns on IONM Company “Surgeon Deals”
By Eric Fader on
On August 18, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) published an Advisory Opinion warning that a common arrangement under which surgeons profit from referrals of their patients for intraoperative neuromonitoring (IONM) services can violate the federal Anti-Kickback Statute (AKS). The Advisory Opinion, the first significant public commentary on…
Fraud Week: Garden State Fraud Roundup; Much Compounding
By Eric Fader on
Here’s a selection of recent healthcare frauds from New Jersey. On April 17, John Sher of Margate was sentenced to 37 months in prison and ordered to pay $2.77 million in restitution and $327,987 in forfeiture for defrauding New Jersey state and local health benefits programs and other insurers. Sher and a co-conspirator recruited state…