OMIG publishes audit protocols to “assist the Medicaid provider community in developing programs to evaluate compliance with Medicaid requirements under federal and state statutory and regulatory law.”[1]  Such protocols are “applied to a specific provider type or category of service in the course of an audit and involve OMIG’s application of articulated Medicaid agency policy

The federal government has demonstrated that it is more than willing to use the United States criminal code to prosecute home care agencies that pay unlawful financial inducements to generate referrals in violation of the Anti-Kickback Statute (AKS).

In a superseding indictment unsealed in March 2025, the United States Attorney’s Office for the Eastern District

Jeff Kaiser’s article, “COVID-19 Pandemic Fraud Enforcement Efforts Overview,” was published on the Lexis Nexis legal research tool, Practical Guidance.

In the article, Jeff offers a comprehensive overview of enforcement efforts related to COVID-19 pandemic fraud.

Just last week, we reported that the 2025/26 NYS Budget Bill did not include a provision that would have increased the requirements for seeking Department of Health (DOH) approval of a material healthcare transaction (which generally means one that increases revenues from healthcare services by at least $25 million) [here]. We have previously written about

We recently wrote about proposed legislation that would have substantially increased the existing reporting requirements for material healthcare transactions in NYS that have existed since Public Health Law (PHL) Article 45-A was enacted two years ago. We provided a detailed review of the current PHL 45-A here and here.

The proposed legislation would have amended PHL 45-A and

With lowering interest rates and federal deregulation, 2025 promises to be a robust comeback year for health care mergers and acquisitions (M&A). At the same time, we’re likely to see more conservative pricing, especially as private equity investors

John Queenan, Mary Aperance and Jeff Ehrhardt wrote, “Quality of Care Considerations in OIG’s nursing Facility Compliance Guidance,” for the spring 2025 issue of USLAW Magazine.

The article details the Industry Segment-Specific Compliance Program Guidance for Nursing Facilities (ICPG) and how the guidance may be used as a basis for investigations and enforcement actions.

To read

On January 15, 2025, the Federal Trade Commission (FTC), Department of Justice (DOJ), and Department of Health and Human Services (HHS) released a joint report continuing their collaborative initiative to address consolidation within the health care sector. This initiative, launched in December 2023, aims to enhance competition and better regulate private equity investments within the

On October 9, 2024, the United States Attorney’s office in the Eastern District of New York unsealed an indictment alleging that eight defendants defrauded Medicaid of approximately $68 million.[1] The alleged scheme involved two adult day care programs and a home care financial intermediary, all owned and controlled by the same individuals, as well as

On October 20, 2024, several significant consumer protection laws will go into effect, directly affecting healthcare providers throughout New York State. Introduced through the FY 2025 Executive Budget, these new laws reshape how providers must handle patient consent to pay for medical services and the use of credit cards for payment.

Separate Consent for Payment