Fraud and Abuse


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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New AKS Safe Harbors Finalized
December 3, 2020 | Geoffrey R. Kaiser | Electronic Health Records | Fraud and Abuse | Hospitals | Legislation and Public Policy | Medical Devices and Wearables | Medicare and Medicaid | Pharmaceuticals | Telehealth
The Office of Inspector General, Department of Health and Human Services (OIG) has finalized new safe harbors and modifications of existing safe harbors under the federal Anti-Kickback Statute (AKS) to reflect a policy priority favoring a value-based health care system that “pays for health and outcomes” and that will “remove potential barriers to more effective …
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Home Health Agency Settles Kickback/Stark Allegations
November 30, 2020 | Eric D. Fader | False Claims Act | Fraud and Abuse | Home Health | Litigation | Medicare and Medicaid
The U.S. Department of Justice announced on November 20 that Doctor’s Choice Home Care, Inc. agreed to pay $3,856,000 to resolve allegations that the agency paid illegal kickbacks to physicians for referring patients. The agency will pay an additional $675,000 to resolve separate allegations that its employees pressured clinical personnel to increase the number of …
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Final Stark Law and Anti-Kickback Rules Released
November 24, 2020 | Eric D. Fader | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid
On November 20, the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services’ Office of Inspector General (OIG) announced the issuance of long-awaited final rules to modernize the Stark Law and federal Anti-Kickback Statute (AKS). Proposed changes, intended to promote value-based arrangements for providers and coordinated care for patients, …
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OIG Issues Special Fraud Alert on Speaker Programs
November 20, 2020 | Eric D. Fader | Fraud and Abuse | Legislation and Public Policy | Litigation | Medical Devices and Wearables | Medicare and Medicaid | Pharmaceuticals
The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) issued a Special Fraud Alert on November 16, warning that speaker programs organized by pharmaceutical and medical device companies pose inherent fraud and abuse risks. OIG is “skeptical about the educational value of such programs” and cautioned that remuneration to referring practitioners …
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Medtronic Settles Kickback and Open Payments Violations for $9.2M
November 13, 2020 | Eric D. Fader | Affordable Care Act | False Claims Act | Fraud and Abuse | Litigation | Medical Devices and Wearables | Medicare and Medicaid
The U.S. Department of Justice (DOJ) announced on October 29 that Medtronic USA Inc. agreed to pay $8.1 million to settle allegations that it violated the False Claims Act (FCA) and federal Anti-Kickback Statute by paying kickbacks to a South Dakota neurosurgeon to use Medtronic’s medical devices. Medtronic will pay an additional $1.11 million for …
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$50 Million Stark Settlement Shows Risk of Violation, Whistleblowers
October 21, 2020 | Rivkin Rounds Staff | False Claims Act | Fraud and Abuse | Hospitals | Litigation | Medicare and Medicaid
An article in the November issue of Healthcare Risk Management, “$50 Million Stark Settlement Shows Risk of Violation, Whistleblowers,” discussed Wheeling Hospital’s $50 million settlement with the U.S. Department of Justice (DOJ) that resolved a whistleblower complaint filed in 2017 by a former executive of the hospital. Rivkin Radler’s Jeff Kaiser was quoted in the …
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