Fraud and Abuse


CMS Issues Guidance on Blanket Stark Law Waivers During COVID-19 Crisis
April 1, 2020 | Geoffrey R. Kaiser | Ada Kozicz | Fraud and Abuse | Home Health | Hospitals | Legislation and Public Policy | Medicare and Medicaid
On March 30, the Secretary of the U.S. Department of Health and Human Services issued blanket waivers of certain requirements of the federal physician self-referral law (Stark Law), retroactive to March 1, in response to the COVID-19 crisis. A detailed discussion of the waivers may be found here. …
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DOJ Takes First Action Against COVID-19 Fraud
March 25, 2020 | Marc S. Ullman | Fraud and Abuse | Litigation
On March 22, the U.S. Department of Justice (DOJ) announced its first action against COVID-19 fraudsters: a civil complaint seeking an injunction ordering the website coronavirusmedicalkit.com to shut down while an investigation into the site’s operators continues. A more detailed discussion of the DOJ’s action may be found here. …
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HHS Issues National Emergency Health Care Waivers
March 23, 2020 | Geoffrey R. Kaiser | Fraud and Abuse | HIPAA | Hospitals | Legislation and Public Policy | Medicare and Medicaid
Responding to the Coronavirus public health emergency, the Secretary of Health and Human Services (HHS) has waived certain requirements of the Medicare, Medicaid and Children’s Health Insurance Program (CHIP), including requirements relating to the Stark Self-Referral Law (“Stark”), the HIPAA privacy regulations and the Emergency Medical Treatment and Labor Act (EMTALA). This action was taken …
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FTC and FDA Take Joint Action to Stop COVID-19 Fraud
March 16, 2020 | Marc S. Ullman | FDA | Fraud and Abuse | Legislation and Public Policy | Litigation
On March 6, the U.S. Food and Drug Administration (FDA) and Federal Trade Commission (FTC) issued joint Warning Letters to seven companies calling for them to cease marketing products appearing to violate federal law by making deceptive or scientifically unsupported claims about their ability to treat Coronavirus (COVID-19). The companies targeted, (1) Vital Silver, (2) Quinessence …
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Second Circuit Cases May Affect Insurers’ Ability To Fight No-Fault Fraud
March 9, 2020 | Rivkin Rounds Staff | Fraud and Abuse | Litigation | Private Insurers
Rivkin Radler’s Evan Krinick authored a March 6 article in the New York Law Journal, “Second Circuit Cases May Affect Insurers’ Ability To Fight No-Fault Fraud,” that discussed two pending cases relating to New York no-fault insurance carriers. Both cases involve a healthcare provider that filed hundreds of new arbitration proceedings or collection lawsuits against …
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NYS to Publicize Physician Misconduct Investigations
January 30, 2020 | Eric D. Fader | Fraud and Abuse | Legislation and Public Policy
New York Gov. Andrew Cuomo’s 2020 State of the State Agenda includes a proposal entitled “strengthening the oversight of physicians and other medical professionals to protect patients.” The proposal includes reforms to the procedures of the state Department of Health’s Office of Professional Medical Conduct (OPMC). The most controversial portion of the proposal would allow …
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OIG Issues Advisory Opinion on Discounted Training
January 21, 2020 | Ada Kozicz | Fraud and Abuse | Hospitals | Legislation and Public Policy | Medicare and Medicaid
In a recent Advisory Opinion, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) approved a proposed arrangement whereby a hospital would offer discounted training to employees of one of the hospital’s referral sources, a local fire department. The hospital is part of a non-profit health system that offers clinical training …
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Medical Equipment Co. to Pay $37.5M to Settle Kickback Claims
January 17, 2020 | Eric D. Fader | False Claims Act | Fraud and Abuse | Litigation | Medical Devices and Wearables | Medicare and Medicaid
The U. S. Department of Justice (DOJ) announced on January 15 that ResMed Corp., a San Diego-based manufacturer of durable medical equipment, will pay $37.5 million to the federal government to settle five qui tam (whistleblower) cases under the False Claims Act (FCA) alleging that ResMed paid kickbacks to DME suppliers, sleep labs and other …
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DOJ Reports $3 Billion in 2019 False Claims Act Recoveries
January 14, 2020 | Eric D. Fader | False Claims Act | Fraud and Abuse | Hospitals | Litigation | Medical Devices and Wearables | Medicare and Medicaid | Pharmaceuticals
The U.S. Department of Justice (DOJ) announced last week that in the fiscal year ended September 30, 2019, it obtained more than $3 billion in total recoveries from civil cases brought under the False Claims Act (FCA). The total, a slight increase from the $2.9 billion recovered in the prior fiscal year, included both settlements …
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The Broad Reach of the Medicare Fraud Strike Forces
January 3, 2020 | Rivkin Rounds Staff | False Claims Act | Fraud and Abuse | Litigation | Medical Devices and Wearables | Medicare and Medicaid | Pharmaceuticals | Telehealth
Rivkin Radler’s Evan Krinick authored an article for the New York Law Journal, “The Broad Reach of the Medicare Fraud Strike Forces.” The article discusses recent strike force actions in New York and New Jersey that targeted a variety of healthcare fraud schemes.   …
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