Fraud and Abuse


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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Genetic Testing Fraudster to Plead Guilty
December 11, 2019 | Eric D. Fader | Fraud and Abuse | Litigation | Medicare and Medicaid | Telehealth
The U.S. Department of Justice’s campaign against genetic testing scams continues and the latest accused lab owner is set to plead guilty. Ravitej Reddy, the owner of Personalized Genetics in Pittsburgh and Med Health Services Management in nearby Monroeville, was charged in November with paying kickbacks in a conspiracy to induce referrals for $127 million …
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NY Deadline Approaching to Certify Compliance Programs
December 9, 2019 | Rivkin Rounds Staff | Fraud and Abuse | Home Health | Hospitals | Legislation and Public Policy | Medicare and Medicaid
The annual December 31st deadline for certain Medicaid providers and third-party billers to certify as to the effectiveness of their compliance program is fast approaching. New York State Medicaid providers and third-party billing companies who claim, bill, order or receive at least $500,000 in any consecutive 12-month period from the Medicaid Program or Managed Medicaid …
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Sutter Health to Pay $45 Million for Stark Law Violations
November 22, 2019 | Eric D. Fader | False Claims Act | Fraud and Abuse | Hospitals | Litigation | Medicare and Medicaid
The U.S. Department of Justice (DOJ) announced on November 15 that Sutter Health, a northern California health system, agreed to pay a total of $45.6 million to settle allegations that it violated the Stark Law in submitting claims to Medicare for services. Sacramento Cardiovascular Surgeons Medical Group Inc. (Sac Cardio), whose physicians referred patients to Sutter, also …
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Life Spine Settles FCA Kickback Case for $6 Million
October 31, 2019 | Eric D. Fader | Affordable Care Act | False Claims Act | Fraud and Abuse | Litigation | Medical Devices and Wearables | Medicare and Medicaid
Spinal implant manufacturer Life Spine Inc. and two of its executives have settled their False Claims Act case by agreeing last week to pay the federal government $6 million. As discussed here, the company and executives had been accused of paying kickbacks to surgeons to use the company’s products. In addition to paying $5.5 million …
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Hospital to Pay $20 Million to Settle Whistleblower Case
October 29, 2019 | Eric D. Fader | False Claims Act | Fraud and Abuse | Hospitals | Litigation | Medical Devices and Wearables | Medicare and Medicaid
The U.S. Department of Justice (DOJ) announced on October 28 that Sanford Health, a hospital in Sioux Falls, South Dakota, will pay $20.25 million to settle a whistleblower lawsuit alleging violations of the False Claims Act and federal Anti-Kickback Statute. Two surgeons at the hospital filed the suit alleging that the hospital allowed another surgeon …
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CMS Announces New Medicare Program Integrity Strategy
October 23, 2019 | Eric D. Fader | Fraud and Abuse | Home Health | Legislation and Public Policy | Medicare and Medicaid
In an October 21 blog post titled “The Future of Medicare Program Integrity,” Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma described a new five-pronged approach to combat waste, fraud, and abuse in the Medicare program. The five “pillars” of the initiative are: Stop bad actors. CMS works with the Office of Inspector …
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