Medicare and Medicaid


CA Lab Pays $3 Million to Settle FCA Case
October 12, 2020 | Rivkin Rounds Staff | False Claims Act | Fraud and Abuse | Litigation | Medicare and Medicaid

On October 2, the U.S. Department of Justice (DOJ) announced that Phamatech, Inc. and its CEO have agreed to pay $3,043,484 to settle alleged False Claims Act (FCA) allegations. San Diego-based Phamatech, a medical technology company that manufactures diagnostic devices and provides laboratory testing, allegedly submitted false claims to Medicare for drug-testing services.

In addition

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A look at 4 value-based care programs
October 5, 2020 | Rivkin Rounds Staff | ACOs | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Private Insurers

A September 30 article in Managed Care Executive, “Are we there yet? A look at 4 value-based care programs,” offered a snapshot of four value-based care programs being undertaken by the Centers for Medicare & Medicaid Services (CMS) and Blue Cross Blue Shield of Massachusetts. Rivkin Radler’s Chris Kutner was quoted in the article.

Chris gave

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HHS Announces $20 Billion in Phase 3 Provider Relief Funding
October 2, 2020 | Ashley (Osadon) Algazi | Behavioral Health | COVID-19 | Legislation and Public Policy | Medicare and Medicaid

On October 1, the U.S. Department of Health and Human Services announced $20 billion in additional funding as part of its Phase 3 Provider Relief Fund. This large push from the government is meant to (a) ensure that all eligible providers who received prior provider relief distributions have a balanced equitable payment equal to 2%

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Gilead Reaches $97 Million FCA/AKS Settlement
September 30, 2020 | Eric D. Fader | False Claims Act | Fraud and Abuse | Litigation | Medicare and Medicaid | Pharmaceuticals

On September 23, the U.S. Department of Justice announced that pharmaceutical company Gilead Sciences, Inc. agreed to pay $97 million to resolve claims that it illegally used a foundation as a conduit to pay the copays of thousands of Medicare patients taking Gilead’s pulmonary arterial hypertension drug Letairis. In addition to the False Claims Act

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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 Janocinska | Behavioral Health | COVID-19 | 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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