Fraud and Abuse

Orthodontic Practice Pays $9 Million Settlement
January 23, 2019 | Eric D. Fader | Fraud and Abuse | Litigation | Medicare and Medicaid
On January 15, New York Attorney General Letitia James announced that Diamond Braces, an orthodontic practice with 10 offices in the State of New York, has settled charges that it allowed uncertified employees to perform orthodontic procedures and then improperly billed the Medicaid program for the procedures. The settlement included $4.5 million in restitution for …
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Rivkin Attorneys to Speak at “The Business of Medicine” Seminar
January 14, 2019 | Rivkin Rounds Staff | Employer/Employee | Fraud and Abuse | HIPAA | Hospitals | Medicare and Medicaid
Rivkin Radler’s Jeffrey Rust and Eric Fader will be among the presenters at “The Business of Medicine,” a seminar to be held on Saturday, January 26, 2019, at the Convene conference center, 101 Park Avenue (at 41st Street), New York, New York. Neuro Alert Services LLC, a multistate provider of intraoperative neurophysiologic monitoring services, designed …
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The False Claims Act: A Powerful Tool Against Federal Health Care Program Fraud
January 7, 2019 | Rivkin Rounds Staff | False Claims Act | Fraud and Abuse | Litigation | Medical Devices and Wearables | Medicare and Medicaid | Pharmaceuticals
Evan Krinick authored an article, “The False Claims Act: A Powerful Tool Against Federal Health Care Program Fraud,” that was published in the New York Law Journal.  The article discusses recent actions taken by U.S. Attorneys in New York against health care providers under the FCA. …
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Diabetes Pill Marketers Settle FTC Complaint
December 14, 2018 | Steven Shapiro | FDA | Fraud and Abuse | Litigation | Pharmaceuticals
On December 4, the Federal Trade Commission (FTC) announced the settlement of a complaint against Nobetes Corporation, which marketed and sold a pill that supposedly treats diabetes. The FTC complaint had alleged that the company made false or unsubstantiated health claims, engaged in illegal billing practices, and used deceptive endorsements in the marketing and sale …
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DOJ Files Amicus Brief Declaring Intention to Dismiss FCA Case
December 12, 2018 | Geoffrey R. Kaiser | FDA | False Claims Act | Fraud and Abuse | Legislation and Public Policy | Litigation | Pharmaceuticals
On November 30, the U.S. Department of Justice (DOJ) filed an amicus curiae brief urging the U.S. Supreme Court to deny a petition for a writ of certiorari filed by Gilead Sciences, Inc. from a Ninth Circuit Court of Appeals decision which had revived a declined False Claims Act (FCA) lawsuit brought by two former …
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OMIG Issues Changes to December 2018 Certification
December 10, 2018 | Ashley (Osadon) Algazi | Fraud and Abuse | Hospitals | Medicare and Medicaid
The New York State Office of the Medicaid Inspector General (OMIG) has issued updates to its certification process for applicable Medicaid and Managed Medicaid providers, which may have a significant impact on providers who are required to certify by December 31, 2018. OMIG has expanded its certification to adopt five separate categories listed on the …
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DOJ Revisits the Yates Memo
December 5, 2018 | Geoffrey R. Kaiser | Fraud and Abuse | Legislation and Public Policy | Litigation
In remarks delivered on November 29 at the American Conference Institute’s 35th International Conference on the Foreign Corrupt Practices Act, Deputy Attorney General Rod J. Rosenstein announced that the U.S. Department of Justice (DOJ) had revised its policy concerning individual accountability in corporate cases. That policy, previously set forth in a September 2015 memorandum issued by …
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Deadline Approaches to Certify Compliance Programs
November 20, 2018 | Ashley (Osadon) Algazi | Fraud and Abuse | Hospitals | Medicare and Medicaid
The December 31 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 payors …
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Dental Clinics are First on OIG’s “High Risk” List
November 16, 2018 | Margarita Christoforou | Fraud and Abuse | Litigation | Medicare and Medicaid
Two dental care companies are the first entities to be placed on the new High Risk – Heightened Scrutiny list created by the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) for providers that pose a significant risk to federal healthcare programs and beneficiaries.  Each of the companies settled with the …
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“Factually False” Billings are Sufficient Basis for FCA Action
November 5, 2018 | Geoffrey R. Kaiser | False Claims Act | Fraud and Abuse | Litigation | Medicare and Medicaid
A federal district court in Illinois, in United States ex rel. Morgan v. Champion Fitness, Inc. et al., No. 1:13-cv-1593 (C.D. Ill, October 19, 2018), recently considered whether the materiality requirement set forth by the U.S. Supreme Court in Universal Health Servs., Inc. v. United States and Massachusetts, ex rel. Escobar, 136 S. Ct. 1989 …
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