Private Insurers

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

On January 24, New York Attorney General Letitia James announced a settlement with EyeMed Vision Care LLC based on shortcomings in the company’s data security procedures. The problems were discovered during the state’s investigation of a 2020 data breach that affected 2.1 million people.

EyeMed, owned by Italian eyeware giant Luxottica Group PIVA, provides vision

Rivkin Radler’s Michael Sirignano wrote an article, “An Insurance Fraud Year in Review,” that was published in the January 6 issue of the New York Law Journal. Among the many cases and settlements discussed were False Claims Act cases involving federal healthcare programs, healthcare fraud related to COVID-19 testing and telehealth services,

The federal No Surprises Act, effective January 1, 2022, established new requirements for healthcare providers, facilities, and providers of air ambulance services to protect consumers from “surprise” medical bills. These requirements are in addition to applicable state laws regulating balance billing and surprise bills.

If a consumer receives care from an out-of-network provider, the patient’s