In recent months, Executive Orders issued by the current Administration regarding gender-affirming care of minors have been the subject of much debate and litigation. The crux of these lawsuits is largely two Executive Orders: Executive Order 14187 (Protecting Children From Chemical and Surgical Mutilation) and Executive Order 14168 (Defending Women From Gender Ideology Extremism and…

Healthcare fraud is prevalent within state Medicaid programs due to the massive amounts of money flowing through the system. In Louisiana, the Estate of Yolanda Burnom and her former company, Community Healthcare Solutions, LLC, recently agreed to pay $4.6 million to settle a False Claims Act lawsuit.

The allegations included providing incentives to Medicaid beneficiaries…

The U.S. Department of Justice (DOJ) announced on February 18 that Health Net Federal Services, LLC and its corporate parent, Centene Corporation, agreed to pay $11,253,400 to resolve False Claims Act (FCA) claims. Health Net, a federal contractor responsible for administering TRICARE, allegedly falsely certified compliance with cybersecurity requirements in its contract with the U.S.

DMERx, an online DME platform, served as the basis for a massive fraud against Medicare and other insurers. Gregory Schreck, a Kansas man who was the vice president of DMERx, orchestrated a sophisticated fraud scheme to bill Medicare and other insurers over $1 billion, resulting in payments of over $350 million. The scheme used DMERx’s…

[THIS INFORMATION HAS BEEN SUPERSEDED] The Financial Crimes Enforcement Network (FinCEN) has announced that beneficial ownership information (BOI) reporting requirements under the Corporate Transparency Act (CTA) are once again back in effect and the new deadline for most businesses to report is March 21, 2025.

While businesses should be prepared to comply with this…

On January 29, the New York State Office of the Medicaid Inspector General (OMIG) published its 2025 Work Plan, which provides a preview of the OMIG’s program integrity initiatives for the upcoming year. While this post highlights several areas that the OMIG will focus on, Medicaid providers should refer to the Work Plan for…

On January 16, the U.S. Drug Enforcement Administration (DEA) announced three new telemedicine rules that extend prescribing flexibilities for controlled substances, following the expiration of temporary flexibilities granted during the COVID-19 pandemic. The new rules, which include both final and proposed regulations, aim to balance patient access with safeguards against misuse.

The rules apply only…

The U.S. Department of Justice announced on January 15 that Jeffrey Paul Madison, the former chief executive officer of a Texas hospital, was sentenced to 36 months in federal prison for conspiring to violate the federal Anti-Kickback Statute (AKS). In October 2024, Madison also agreed to pay over $5.3 million to settle allegations under the…