Private Insurers

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

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

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

The U.S. Department of Justice (DOJ) announced on April 20 that it has brought criminal charges against 18 defendants across the U.S. for various fraud schemes related to the COVID-19 pandemic. The DOJ seized more than $16 million in cash and other proceeds from the schemes, which resulted in more than $490 million in false

An article in the March 20 issue of the Report on Medicare Compliance, “New NYS Compliance-Program Requirements May Be Useful Everywhere as a ‘Fresh Look,’” discussed the final compliance and self-disclosure regulations released by the New York Office of Medicaid Inspector General (OMIG) on December 28. Rivkin Radler’s Bob Hussar was quoted in

Rivkin Radler’s Michael Sirignano authored an article for the March 2 issue of the New York Law Journal entitled “Healthcare Fraud Tops DOJ’s Annual False Claims Act Report – Again!” The article discussed a report issued by the U.S. Department of Justice detailing the settlements and judgments it obtained under the federal False

On the heels of publishing their final regulations, on January 31, the New York Office of the Medicaid Inspector General (OMIG) released a variety of guidance documents addressing compliance programs; self-disclosure; and Medicaid managed care fraud, waste and abuse prevention programs. The guidance documents can be found at:

Provider Compliance Programs

Self-Disclosure Program

Medicaid Managed

In the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler’s Bob Hussar, Ashley Algazi and Mary Connolly will present “OMIG’s FINALIZED Regulations: What You Need to Do – NOW!”

On December 28, the Office of Medicaid Inspector General (OMIG) released their final compliance and self-disclosure regulations. The regulations implement 2020

For those who just can’t get enough fraud, here are some of the “leftovers” from this edition of Fraud Week that your editor thought noteworthy.

Read about a pharmacy biller’s fake copay assistance scheme:

https://www.justice.gov/usao-edmi/pr/woman-convicted-billing-claims-part-65-million-pharmaceutical-coupon-fraud

Genetic testing kickback schemes

In TX: https://www.justice.gov/opa/pr/laboratory-owners-and-executives-charged-health-care-kickback-scheme

In FL: https://www.justice.gov/opa/pr/ocenture-llc-and-carelumina-llc-settle-allegations-false-claims-unnecessary-genetic-testing

And here’s a big one in GA: https://www.justice.gov/opa/pr/lab-owner-convicted-463-million-genetic-testing-scheme-defraud-medicare

DME kickback