Medicare and Medicaid


NJ EHR Company Reaches $500,000 FCA Settlement
September 8, 2020 | 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 August 27 that New Jersey-based Konica Minolta Healthcare Americas Inc. agreed to pay $500,000 to resolve allegations that its former subsidiary, Viztek LLC, misrepresented the capabilities of its electronic health records (EHR) software, which caused users of the software to file false claims with the federal government. …
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Teva under Fire from DOJ
August 27, 2020 | Eric D. Fader | Antitrust | False Claims Act | Fraud and Abuse | Litigation | Medicare and Medicaid | Pharmaceuticals
Teva Pharmaceuticals USA Inc. is in the crosshairs of the U.S. Department of Justice (DOJ) on two separate matters. On August 18, the DOJ announced that it filed a lawsuit against Teva and an affiliate, Teva Neuroscience Inc., under the False Claims Act for violations of the federal Anti-Kickback Statute. The suit alleges that the …
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CMS Proposes Permanent Expansion of Telehealth Services
August 5, 2020 | Ada (Kozicz) Janocinska | Behavioral Health | Home Health | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Telehealth
In response to the COVID-19 pandemic since mid-March, the Centers for Medicare and Medicaid Services (CMS) worked quickly to issue emergency guidance that allowed temporary expansion of payment for telehealth services and provided certain flexibility in providing telehealth services. The COVID pandemic has significantly increased awareness of the benefits of telehealth, as many patients have …
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HHS, DOJ Release Fraud and Abuse Report
July 23, 2020 | Eric D. Fader | Electronic Health Records | False Claims Act | Fraud and Abuse | Home Health | Hospitals | Litigation | Medical Devices and Wearables | Medicare and Medicaid | Pharmaceuticals | Telehealth
The U.S. Department of Health and Human Services (HHS) and Department of Justice (DOJ) have released the 2019 annual report for their Health Care Fraud and Abuse Control Program. The government recovered almost $3.6 billion, of which about $2.5 billion was returned to the Medicare trust fund. The recoveries included judgments and settlements from fraud …
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Time to Prepare for Possible Medicaid Home Care Changes
July 9, 2020 | Wendy Hoey Sheinberg | Home Health | Legislation and Public Policy | Medicare and Medicaid | Nursing Homes
Community Medicaid Services will undergo a significant change on October 1, 2020, due to the passage of the New York State Budget Bill (“2020 Bill”). Although many of the changes in the 2020 Bill are subject to federal approval, this bulletin will offer an overview of what might be affected. You can take steps now …
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VNSNY Agrees to $57 Million Settlement
June 29, 2020 | Eric D. Fader | False Claims Act | Fraud and Abuse | Home Health | Litigation | Medicare and Medicaid
The Visiting Nurse Service of New York (VNSNY) has agreed to pay $57 million to settle a whistleblower lawsuit that alleged it billed the Medicare and Medicaid programs for hundreds of millions of dollars in home care visits that were not actually provided. The lawsuit, originally filed in 2014 by a former executive of VNSNY, …
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Drug Price Disclosure Rule Rejected Again
June 17, 2020 | Eric D. Fader | Legislation and Public Policy | Medicare and Medicaid | Pharmaceuticals
On June 16, the U.S. Court of Appeals for the District of Columbia Circuit upheld a ruling from a year ago that struck down a federal regulation requiring pharmaceutical companies to disclose wholesale prices of prescription drugs in television advertisements. The appeals court agreed with the lower court’s opinion that the rule exceeded the legal …
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Navajo National Collaboration Could Greatly Boost Molina’s Flagging Fortunes in New Mexico
June 2, 2020 | Rivkin Rounds Staff | Medicare and Medicaid | Private Insurers | Telehealth
A recent article in Health Payer Specialist, “Navajo National Collaboration Could Greatly Boost Molina’s Flagging Fortunes in New Mexico,” discussed how Molina Healthcare, through the Navajo Managed Care Organization (MCO), is working to better the healthcare of the Navajo Nation while bolstering its own bottom line. Rivkin Radler’s Chris Kutner was quoted in the article. …
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False Claims Act, Medical Necessity and Government Regulation of Medicine
May 14, 2020 | Rivkin Rounds Staff | False Claims Act | Fraud and Abuse | Hospitals | Litigation | Medicare and Medicaid
Rivkin Radler’s Geoffrey R. Kaiser authored an article for Law360 entitled “False Claims Act, Medical Necessity and Government Regulation of Medicine.” The full article can be found here. …
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CMS Announces Further Rule Changes to Address Pandemic
May 4, 2020 | Eric D. Fader | ACOs | Behavioral Health | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Telehealth
On April 30, the Centers for Medicare & Medicaid Services (CMS) announced numerous regulatory waivers and rule changes to, among other things, expand Medicare beneficiaries’ access to coronavirus testing and telehealth services. CMS also made changes to address financial concerns that had been raised by many accountable care organizations (ACOs). The changes included adding behavioral …
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