Medicare and Medicaid


Pathology Lab Company to Pay $63.5 Million to Settle FCA Case
February 5, 2019 | Christopher J. Kutner | Electronic Health Records | False Claims Act | Fraud and Abuse | Litigation | Medicare and Medicaid

Inform Diagnostics, a Texas-based pathology laboratory company, will pay the federal government $63.5 million to resolve allegations that the company violated the False Claims Act (FCA). The U.S. Department of Justice announced the settlement on January 30.

Inform Diagnostics was alleged to have engaged in improper financial relationships with physicians, including providing them with subsidies

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Walgreens Pays $269.2 Million to Settle Fraud Allegations
January 24, 2019 | Geoffrey R. Kaiser | False Claims Act | Fraud and Abuse | Litigation | Medicare and Medicaid | Pharmaceuticals

Walgreens Boots Alliance, Inc., the operator of the Walgreens pharmacy chain, has agreed to pay $269.2 million in two settlements with the U.S. Department of Justice to resolve fraud allegations. The two cases arose from lawsuits filed by whistleblowers under the False Claims Act and were prosecuted federally by the U.S. Attorney’s Office for the Southern

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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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Starting the New Year with Hospital Price Transparency
January 8, 2019 | Affordable Care Act | Hospitals | Legislation and Public Policy | Medicare and Medicaid

As of January 1, hospitals are now required to post charges for their standard items and procedures online in an effort to increase price transparency. Section 2718(e) of the Public Health Service Act, part of the Affordable Care Act, requires each hospital in the U.S. “for each year [to] establish (and update) and make public

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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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Here’s Why Your Tax Dollars Are Overpaying for Medicaid
January 3, 2019 | Rivkin Rounds Staff | Legislation and Public Policy | Medicare and Medicaid

A January 2 article in Bloomberg Law’s Health Law & Business, “Here’s Why Your Tax Dollars Are Overpaying for Medicaid,” discussed the Medicaid program’s difficulty in recovering inappropriate payments made by states to doctors. A December 11 report by the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) said the lack

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Midterm Election Results: 6 Ways Healthcare Could Change in 2019
December 27, 2018 | Rivkin Rounds Staff | Affordable Care Act | Legislation and Public Policy | Medicare and Medicaid | Pharmaceuticals

A December 6 article in Managed Healthcare Executive, “Midterm Election Results: 6 Ways Healthcare Could Change in 2019,” discussed how Congress may attempt to address various healthcare issues next year. Rivkin Radler’s Eric Fader was quoted in the article.

Eric pointed out that the recently enacted Know the Lowest Price Act and Patient Right to Know Drug Prices Act will

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Hospitals Still Faxing and Mailing Patient Records
December 21, 2018 | Eric D. Fader | Electronic Health Records | Hospitals | Medicare and Medicaid

A recent study by the Office of the National Coordinator for Health Information Technology revealed that most hospitals were still transmitting at least some patient medical records by mail or fax in 2017. The data showed that industry-wide electronic interoperability remains a distant goal.

According to the study, 66% of the hospitals surveyed sometimes sent

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OMIG Issues Changes to December 2018 Certification
December 10, 2018 | Ashley 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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