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…

In the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler’s Bob Hussar will discuss the first two required elements of an Effective Compliance Program:

1. Policies and Procedures; and

2. Compliance Officer/Compliance Committee

Bob is a partner in Rivkin Radler’s Compliance, Investigations & White Collar and Health Services practice groups.

A recent article in Part B News, “Be careful about upcoding; DOJ may come after it as a false claim,” discussed how the U.S. Department of Justice frequently prosecutes improper billing of CPT codes for Medicare patients. Rivkin Radler’s Jeff Kaiser was quoted in the article.

“Sometimes, a provider will upcode a…

The U.S. Department of Justice announced on February 27 that the University of Pittsburgh Medical Center (UPMC), James Luketich, its Chair of Cardiothoracic Surgery, and University of Pittsburgh Physicians have agreed to pay $8.5 million to settle a qui tam suit brought by a former UPMC cardiothoracic surgeon. The suit, brought under the False Claims…

On February 17, Daniel Russo, a Long Island resident, pleaded guilty in federal court in Brooklyn to multiple charges in connection with illegally distributing oxycodone. Russo faces decades in federal prison when he is sentenced.

Russo owned and operated Russo’s Pharmacy in Far Rockaway, Queens. From 2011 to 2014, he filled thousands of fraudulent prescriptions…

The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) announced on February 2 that Banner Health, a not-for-profit hospital system based in Arizona, has paid $1.25 million in order to settle alleged HIPAA violations in connection with a cyber attack.

The incident occurred in 2016 when a hacker gained access to…

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…