Fraud and Abuse


Zocdoc Fees Get Anti-Kickback Approval
September 18, 2019 | Eric D. Fader | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid
The online appointment booking service Zocdoc has received a favorable Advisory Opinion from the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) confirming that Zocdoc’s new per-click or per-booking fee model does not violate the federal Anti-Kickback Statute (AKS). Without AKS concerns, Zocdoc may now allow Medicare, Medicaid, and other federal …
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Kaiser to Present at PLI Life Sciences Program
September 17, 2019 | Rivkin Rounds Staff | Cybersecurity | Electronic Health Records | FDA | False Claims Act | Fraud and Abuse | Legislation and Public Policy | Litigation | Medical Devices and Wearables | Medicare and Medicaid | Pharmaceuticals | Private Insurers
On October 10, Rivkin Radler’s Jeff Kaiser will be a panelist at the Practising Law Institute (PLI) program, “Life Sciences 2019: Navigating Legal Challenges in the Drug and Device Industries.” Jeff will speak on “Enforcement Trends Impacting the Drug and Device Industries,” including developments under the False Claims Act, federal Anti-Kickback Statute, off-label promotion, and …
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FCA Ruling: Proof of Falsity Needed to Show Fraud
September 16, 2019 | Geoffrey R. Kaiser | False Claims Act | Fraud and Abuse | Hospitals | Legislation and Public Policy | Litigation | Medicare and Medicaid
Last week, the 11th Circuit Court of Appeals handed down its long-awaited decision in United States v. AseraCare, Inc. The case, brought under the False Claims Act (FCA) and argued way back in March 2017, alleged that AseraCare, a for-profit multi-state hospice chain, had submitted false claims to the Medicare program for patients who were …
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New Rule Augments CMS’s Fraud-Fighting Powers
September 13, 2019 | Eric D. Fader | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid
On September 5, the Centers for Medicare & Medicaid Services (CMS) announced the issuance of a final rule that will allow the agency to deny or revoke a healthcare provider’s or supplier’s federal program enrollment if it is “affiliated” with another previously revoked organization. The rule had originally been proposed more than three years ago. …
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Kickback Charges Lead to False Claims Act Case
August 27, 2019 | Eric D. Fader | Affordable Care Act | False Claims Act | Fraud and Abuse | Litigation | Medical Devices and Wearables | Medicare and Medicaid
The Manhattan U.S. Attorney’s Office recently announced that the U.S. Department of Justice has intervened in a whistleblower suit against Life Spine Inc., an Illinois-based manufacturer of spinal implants, devices and equipment. The lawsuit, which seeks damages and civil penalties under the False Claims Act (FCA), claims that Life Spine paid millions of dollars in …
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Genetic Testing Scam Targets Medicare Beneficiaries
August 14, 2019 | Eric D. Fader | Fraud and Abuse | Medicare and Medicaid
The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) issued a Fraud Alert on August 13 regarding a genetic testing scam targeting Medicare beneficiaries. The scammers will offer a “free” screening for genetic testing but then submit a claim to Medicare, which will likely deny the claim as medically unnecessary. The …
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Anesthesiologist Charged with Telemedicine Fraud
July 11, 2019 | Eric D. Fader | Fraud and Abuse | Litigation | Medicare and Medicaid | Pharmaceuticals | Telehealth
A New York anesthesiologist was indicted on July 9 for conspiring with pharmacies and medical equipment suppliers to defraud the Medicare program and other insurers. Anna Steiner, also known as Hanna Wasielewska, allegedly wrote prescriptions for drugs and durable medical equipment for patients supposedly seen via telemedicine without ever having actually examined or evaluated the …
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Proposed Stark Law Revisions Expected Soon
June 28, 2019 | Eric D. Fader | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid
The Centers for Medicare & Medicaid Services (CMS) expects to release proposed revisions to the federal physician self-referral prohibition (Stark Law) before Labor Day, according to Kim Brandt, CMS’s principal deputy administrator for operations. Brandt was speaking at an industry conference. Potential Stark Law changes were recently discussed here. CMS had requested input from the …
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Physician Jailed for Prescribing Drugs to Non-Patients
June 18, 2019 | Margarita Christoforou | Fraud and Abuse | Litigation | Pharmaceuticals
A physician who operated weight-loss clinics in Georgia is facing 33 months in prison after pleading guilty to Conspiracy to Unlawfully Dispense Controlled Substances (Oxycodone), according to a June 13 press release issued by the U.S. Department of Justice. Dr. Johnny Di Blasi was arrested at Miami International Airport as he was attempting to flee …
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Insys Settles Kickback Case, Files for Bankruptcy
June 12, 2019 | Eric D. Fader | False Claims Act | Fraud and Abuse | Litigation | Pharmaceuticals
The U.S. Department of Justice announced on June 5 that Arizona-based opioid manufacturer Insys Therapeutics agreed to pay $225 million to settle civil and criminal kickback charges. Last month, Insys’s founder and former CEO John Kapoor was found guilty on federal racketeering charges arising out of a bribery scheme that rewarded the company’s sales managers …
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