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.
Private Insurers
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…
Fraud Week: DOJ Announces COVID-Related Fraud Sweep
By Eric Fader on
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…
New NYS Compliance-Program Requirements May Be Useful Everywhere as a ‘Fresh Look’
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…
Healthcare Fraud Tops DOJ’s Annual False Claims Act Report – Again!
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…
OMIG Update: Compliance, Self-Disclosure, and Managed Care Fraud, Waste and Abuse Guidance Posted
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: