Private Insurers

If our most recent Fraud Week post (NY Chiropractor Billed for Non-Existent Acupuncture Services) didn’t already drive home the point, it is worth emphasizing that billing insurers for items or services that weren’t actually provided is always a bad idea.

On August 4, the U.S. Department of Justice (DOJ) announced that Ariel Madero

On August 15, the U.S. Department of Justice (DOJ) announced that a Long Island chiropractor pleaded guilty to healthcare fraud for billing a private insurance company over $1 million for acupuncture services that were never performed. The investigation of Peter Adamczak was a joint effort by DOJ, the New York State Inspector General, and the

Healthcare fraud related to durable medical equipment (DME) is extremely costly to insurers, yet often continues without criminal or civil consequences. Rivkin Radler’s Michael Vanunu recently wrote an article on the topic for Law360.

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The Centers for Medicare & Medicaid Services’ Transparency in Coverage Final Rule took effect on July 1, following a six-month delay in implementation to allow payers to come into compliance.

The Final Rule requires group health plans and health insurance issuers offering non-grandfathered coverage in the group and individual markets to disclose online, in machine-readable

On May 11, New York Gov. Kathy Hochul announced the establishment of the Pharmacy Benefits Bureau within the State’s Department of Financial Services (DFS). The Bureau will handle the licensing and supervision of pharmacy benefit managers (PBMs), and in particular their impact on consumers and the cost of healthcare. The Bureau will also have authority

Regulators are now better armed to cite and fine health plans that are not complying with the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. A recent report to Congress highlights the enforcement work to date and illustrates the extent to which many plans are noncompliant with the law. The result is that

The U.S. Department of Justice (DOJ) announced on March 3 that Ameet Goyal, M.D., a Westchester-based ophthalmologist, was sentenced to 96 months in prison for falsely billing for millions of dollars of upcoded procedures over seven years, and for fraudulently obtaining two business loans under the CARES Act’s Paycheck Protection Program (PPP) in the early

Rivkin Radler’s Michael Sirignano wrote an article, “The Opioid Crisis: An Epidemic Exacerbated by Fraud,” that appeared in the March 3 issue of the New York Law Journal. The article discussed the various types of opioid fraud, including illegal distribution, fake prescriptions, illegal dispensing by pharmacies, and medically unnecessary procedures.

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In a February 23 order, the U.S. District Court for the Eastern District of Texas vacated a controversial rule issued in September that implemented the independent dispute resolution (IDR) procedure under the federal No Surprises Act (NSA). The lawsuit[1] was brought by the Texas Medical Association. Numerous industry participants had complained that the

On Thursday, March 10, in the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler’s Chris Kutner and Ashley Algazi will discuss Compliance and Legal Considerations for Value Based Arrangements. The program will take place from 12:00 noon to 1:00 PM Eastern time via Zoom.

The topics covered will include:

  • Framework