Fraud and Abuse


OIG Issues Favorable Advisory Opinion on Hospital/Physician Joint Venture ASC
May 5, 2021 | Ada (Kozicz) Janocinska | Fraud and Abuse | Hospitals | Legislation and Public Policy
In a recent advisory opinion, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) concluded that certain investments by a health system, manager and physicians in an ambulatory surgery center (ASC) did not create a substantial risk of fraud and abuse under the federal Anti-Kickback Statute (AKS) even though the investments …
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Insurance Fraud Scheme Lands Chiropractor in Prison
April 16, 2021 | Margarita Christoforou | Fraud and Abuse | Litigation | Medicare and Medicaid
The U.S. Department of Justice (DOJ) announced on April 13 that James Spina, a licensed chiropractor and the unlawful operator of Dolson Avenue Medical, P.C. (DAM), was sentenced to nine years in prison and three years of post-release supervision. DAM, a multi-disciplinary medical practice in Middletown, New York, purported to provide a variety of pain …
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Free Drug Program Avoids Sanctions Under AKS
April 6, 2021 | Ada (Kozicz) Janocinska | FDA | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid | Pharmaceuticals
In a recent advisory opinion, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) determined not to impose sanctions under the federal Anti-Kickback Statute (AKS) on a drug manufacturer program that offers a free drug to certain eligible patients. The manufacturer uses personalized medicine technology to make the drug from the …
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Pandemic response, fraud and abuse top Biden’s enforcement priorities
March 31, 2021 | Rivkin Rounds Staff | COVID-19 | False Claims Act | Fraud and Abuse | HIPAA | Hospitals | Legislation and Public Policy | Litigation
A March 24 article in Wolters Kluwer’s Health Law Daily, “STRATEGIC PERSPECTIVES: Pandemic response, fraud and abuse top Biden’s enforcement priorities,” quoted healthcare industry experts who predict increased enforcement in the areas of fraud and abuse, False Claims Act (FCA) cases, and pandemic-related waivers. Rivkin Radler’s Robert Hussar was quoted in the article. Among Bob’s …
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NYC Pharmacy Owner Charged with Healthcare Fraud
March 23, 2021 | Margarita Christoforou | Fraud and Abuse | Litigation | Medicare and Medicaid | Pharmaceuticals
The owner of Brooklyn Chemists in Gravesend, Brooklyn and Lucky Care Pharmacy in Flushing, Queens was recently indicted on charges of conspiracy to commit health care fraud, conspiracy to defraud the United States by paying kickbacks and bribes in connection with the provision of health care services, and unlawfully spending the proceeds of the fraud. …
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False Claims Act Cases Poised to Jump Now and for Years to Come
March 4, 2021 | Rivkin Rounds Staff | Behavioral Health | False Claims Act | Fraud and Abuse | Hospitals | Litigation | Medical Devices and Wearables | Medicare and Medicaid | Pharmaceuticals
Rivkin Radler’s Evan H. Krinick wrote an article entitled “False Claims Act Cases Poised to Jump Now and for Years to Come” that was published in the March 5, 2021 issue of the New York Law Journal. The article discusses health insurance fraud cases in 2020 that involved kickbacks, provision of medically unnecessary services, and …
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California Laboratory Settles FCA Claims Related to Genetic Testing
February 10, 2021 | Rivkin Rounds Staff | False Claims Act | Fraud and Abuse | Litigation | Medicare and Medicaid
Exceltox Laboratories, LLC, a California diagnostic laboratory, is paying a $357,584 settlement to resolve allegations of False Claims Act (FCA) violations. Exceltox allegedly submitted or caused to be submitted claims for genetic tests to Medicare without valid physician oversight. In 2015, Exceltox engaged an independent contractor, Seth Rehfuss, who persuaded residents of low-income senior housing …
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Two Indicted in $100 Million Home Health Care Fraud Scheme
February 4, 2021 | Christopher J. Kutner | Fraud and Abuse | Home Health | Litigation | Medicare and Medicaid
The U.S. Department of Justice (DOJ) announced on February 1 that an owner and operator of Arbor Homecare Services LLC and a nurse employed by the home health agency were indicted for their roles in a scheme to defraud MassHealth and Medicare of at least $100 million. The Massachusetts agency allegedly routinely billed the government …
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EHR Vendor to Pay $18.25 Million to Resolve Kickback Allegations
January 29, 2021 | Eric D. Fader | Electronic Health Records | False Claims Act | Fraud and Abuse | Litigation | Medicare and Medicaid
The U.S. Department of Justice (DOJ) announced on January 28 that athenahealth Inc., a Massachusetts-based electronic health records (EHR) technology vendor, has agreed to pay $18.25 million to resolve allegations that it paid illegal kickbacks to generate sales of its EHR product, athenaClinicals. The settlement is the government’s latest reminder that marketing initiatives that are …
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Substance Abuse Center and CEO in $6 Million Medicaid Fraud Settlement
January 6, 2021 | Margarita Christoforou | Behavioral Health | False Claims Act | Fraud and Abuse | Litigation | Medicare and Medicaid
On December 21, New York State Attorney General Letitia James announced a $6 million settlement of a civil healthcare fraud lawsuit against A.R.E.B.A-Casriel, Inc. d/b/a Addiction Care Interventions Chemical Dependency Treatment Centers (ACI) and its former owner and CEO, Steven Yohay. ACI will pay $3 million and Yohay will pay an additional $3 million personally …
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