RECENT HEALTH LAW NEWS

How to Handle Payer Record Request and Subsequent Demand for Alleged Overpayments
September 12, 2025 | Rivkin Rounds Staff | Medicare and Medicaid | Private Insurers

On Thursday, September 18, in the next installment of Rivkin Radler’s Health Law Executive Briefings, Chris Kutner and Ashley Algazi will present “How to Handle Payer Record Request and Subsequent Demand for Alleged Overpayments.” The presentation will provide a comprehensive review of the issues and best practices for responding to,…
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The New York Attorney General’s office recently announced an agreement with MVP Health Care under which the insurer will pay $250,000 in penalties, fees, and costs to the state for maintaining an inaccurate mental health provider directory. The settlement is the first arising out of an investigation of so-called “ghost…
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The Changing Face of New York’s Medicaid Home Care Program Cuts Deep
August 25, 2025 | Wendy Sheinberg and Mohammed Haque | Home Health | Legislation and Public Policy | Medicare and Medicaid

New York State’s Medicaid Home Care program pays for in-home personal care services. New York’s program has long been the best in the country. One underlying policy behind the program was that people should have every opportunity to remain in the community. A community focus provides two benefits: the social…
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DOJ Statement of Interest Filed Prohibiting Dysphoria Medical Coverage
August 22, 2025 | Emily Manning | Legislation and Public Policy | Litigation | Private Insurers

The U.S. Department of Justice recently issued a press release concerning a Statement of Interest that shields small businesses from being forced to provide medical coverage for gender dysphoria. In Bernier v. Turbocam et al., the Plaintiff, who identifies as a woman and has been diagnosed with gender dysphoria, claims denial…
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Is It Time for Medically Assisted End of Life?
August 15, 2025 | Patricia Marcin | Legislation and Public Policy

While a 2024 poll indicated New Yorkers’ overwhelming support for New York’s Medical Aid in Dying Act for terminally ill people (M.A.I.D.), the act had not been approved by the legislature each time it had been presented, despite support from the New York State Bar Association, the American College of…
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Flo Health Data-Sharing Case Ends in Major Jury Verdict Against Meta
August 15, 2025 | Atara Kahn | Electronic Health Records | Litigation

Meta Inc., the parent company of Facebook, Instagram and WhatsApp, has been found liable by a California federal jury for improperly using sensitive reproductive health data to run targeted ads, in a case involving the popular Flo Health period-tracking app. Eight women brought the lawsuit on behalf of a class…
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Aspen Dental Settles Data-Sharing Class Action
August 13, 2025 | Sean Simensky | Dentistry | Electronic Health Records | Litigation

Dental service organization (DSO) Aspen Dental has agreed to pay $18.7 million to resolve claims that it secretly shared web user data with Meta and Google, without obtaining users’ consent or informing them. The claims are part of a class action lawsuit brought against Aspen Dental in Illinois State Court,…
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On September 18, Rivkin Radler’s Jeff Kaiser will participate on a panel at Practising Law Institute’s Life Sciences 2025: Navigating Legal Challenges in Drug and Device Industries. Jeff’s panel is entitled “Enforcement Trends Impacting the Drug and Device Industries.” Held at PLI’s NY Conference Center, located at 1177 Avenue of…
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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…
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An article in the August issue of Healthcare Risk Management, “DOJ Targeting Healthcare for False Claims Act Enforcement,” discussed recent enforcement activity by the U.S. Department of Justice (DOJ) under the False Claims Act (FCA). Rivkin Radler’s Jeff Kaiser was quoted in the article. Jeff predicted that the FCA will continue…
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The epidemic of out-of-control generative artificial intelligence in litigation filings has metastasized to a False Claims Act (FCA) lawsuit against a group of Utah anesthesiologists. On July 25, Mountain West Anesthesia, LLC and individual defendants in the case moved to bar the testimony of a medical billing expert whose report…
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NY Medical Transport Owner Sentenced for Medicaid Fraud
July 18, 2025 | Emily Manning | Fraud and Abuse | Litigation | Medicare and Medicaid

The owner of Sublime Medical Transportation in Schenectady County, New York was recently sentenced to three to nine years in state prison for orchestrating a large Medicaid fraud scheme. Muhammed Adnan Saeed netted over $700,000, along with more than $60,000 in unemployment benefits to which he was not entitled. Between…
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On July 2, the U.S. Department of Justice (DOJ) and Department of Health and Human Services (HHS) announced the formation of the DOJ-HHS False Claims Act Working Group to strengthen “their ongoing collaboration to advance priority enforcement areas” in combating healthcare fraud. The two agencies cited the long history of…
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Cigna filed a lawsuit on June 24 in Manhattan federal court accusing Bristol Myers Squibb of unlawfully blocking generic versions of its blood cancer drug, Pomalyst, from entering the market. The suit also names Celgene, a Bristol Myers subsidiary that originally developed and marketed the drug. Cigna alleges that Celgene…
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The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) has announced another settlement for alleged violations of HIPAA. OCR investigated BayCare Health System, which serves central Florida, after a patient complained to OCR in 2018 that her medical record was accessed by an unauthorized individual. The…
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Tennr’s AI Platform Targets Referral “Black Holes” with $101 Million in New Funding
June 26, 2025 | Atara Kahn | Artificial Intelligence

Tennr, a healthcare technology company focused on streamlining healthcare operations, recently announced the receipt of $101 million in funding. While the investment signals growing confidence in AI-enabled administrative tools, Tennr’s real innovation lies in the technology it has developed to address one of healthcare’s most persistent inefficiencies: the referral process.…
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Long Island Doctor Charged with Grand Larceny for Benefits Scam
June 25, 2025 | Chris Kutner | Fraud and Abuse | Litigation | Medicare and Medicaid

The Nassau County District Attorney recently charged Joseph Golyan, a Great Neck gastroenterologist, with collecting Social Security and other government benefits over a four-year period, while simultaneously billing Medicare for care he was providing to Medicare beneficiaries. He allegedly collected over $100,000 in disability benefits, while billing Medicare over $700,000,…
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Last month, the head of the Criminal Division of the U.S. Department of Justice (DOJ), Matthew R. Galeotti, issued a Memorandum outlining DOJ’s enforcement priorities and policies for prosecuting white-collar crime, identifying three core tenets to guide prosecutors: “(1) focus; (2) fairness; and (3) efficiency.” Among the areas of focus…
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Digital Health Startup Raises $45M to Expand AI Care Manager Tool
June 17, 2025 | Atara Kahn | Artificial Intelligence | Behavioral Health

Ellipsis Health, a digital health startup based in San Francisco, recently announced that it raised $45 million in a Series A-1 funding round led by Salesforce Ventures, CVS Health Ventures, and Khosla Ventures. The funding will be used to further develop Sage, the company’s AI-powered care manager, and expand its…
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CMS Rescinds EMTALA Abortion Guidance Amid Ongoing Legal Conflicts
June 13, 2025 | Emily Manning | Hospitals | Legislation and Public Policy | Medicare and Medicaid

The Centers for Medicare & Medicaid Services (CMS) recently published a press release rescinding its June 2022 guidance concerning hospitals’ obligations to pregnant women under the Emergency Medical Treatment & Labor Act (EMTALA). EMTALA is a federal law that requires hospitals to provide emergency care to all patients, regardless of…
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To ease doctor-departing woes, write careful terms into the contract
June 13, 2025 | Rivkin Rounds Staff | Employer/Employee

An article in the June 9 issue of Part B News, “To ease doctor-departing woes, write careful terms into the contract,” discussed best practices for medical practices’ employment contracts with their physician employees. Rivkin Radler’s Norton Travis was quoted in the article. Norton suggested that practices try to enforce restrictive covenants…
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Two Pennsylvania nursing home operators were recently sentenced in federal court to pay more than $15 million in restitution in a healthcare fraud case. Comprehensive Healthcare Management Services, the operator of Brighton Rehabilitation and Wellness Center, and the affiliated operator of Mount Lebanon Rehabilitation and Wellness Center were convicted of…
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FBI Warns Consumers of Discount Medical Scams
May 29, 2025 | Emily Manning | Fraud and Abuse | Private Insurers

On April 30, the Federal Bureau of Investigation (FBI) released a Public Service Announcement warning consumers about fraudulent discount medical scams. These scams typically involve deceptive offers for health insurance plans that, in reality, provide little to no legitimate coverage. Scammers are contacting people through text messages, phone calls, or…
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Jeff Kaiser’s article, “COVID-19 Pandemic Fraud Enforcement Efforts Overview,” was published in the LexisNexis legal research tool, Practical Guidance. In the article, Jeff offers a comprehensive overview of enforcement efforts related to COVID-19 pandemic fraud. Sign up to receive Rivkin Rounds at www.RivkinRounds.com. Continue Reading
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NYS DOH Releases New Electronic Material Transaction Form
May 21, 2025 | Norton Travis, Jeffrey Ehrhardt and Emily Manning | Legislation and Public Policy | Mergers and Acquisitions

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].…
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Seventh Circuit Rejects Extension of AKS to Marketing Companies Without Evidence of Intent to Induce Referrals
May 20, 2025 | Syma Levine | Fraud and Abuse | Litigation

The U.S. Court of Appeals for the Seventh Circuit recently rejected an effort by the federal government to extend the federal Anti-Kickback Statute (AKS) to a marketing company in the absence of influence by the company over decision makers. Mark Sorensen, the owner of SyMed Inc., a durable medical equipment (DME) distributor,…
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Expanded Healthcare Transaction Notice/Review Dropped from Final 2025/26 NYS Budget Bill
May 16, 2025 | Norton Travis and Jeffrey Ehrhardt | Legislation and Public Policy | Mergers and Acquisitions

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…
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On May 1, a whistleblower filed a complaint under the federal False Claims Act (FCA) against Aetna, Elevance Health (formerly Anthem) and Humana alleging that the insurers paid hundreds of millions of dollars in illegal kickbacks to induce brokers including GoHealth, eHealth and SelectQuote (the “Brokers”) to steer beneficiaries to…
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Practice Transitions for the Practicing Dentist
May 09, 2025 | Rivkin Rounds Staff | Dentistry | Mergers and Acquisitions

On Thursday, May 29 at 12:00 PM, Rivkin Radler Partners Benjamin Malerba and Sean Simensky will present the webinar “Practice Transitions for the Practicing Dentist.” This lecture is designed to inform dentists of some of the legal and practical issues surrounding practice transitions. Ben and Sean will explore the differing…
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The U.S. Attorney’s Office for the Eastern District of Pennsylvania announced on April 23 that Genexe, LLC (doing business as Genexe Health) and its parent company, Immerge, Inc., along with two of their executive officers/owners, Jason Green and Jason Gross, collectively agreed to pay $6 million to settle claims that…
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OIG Audit of MACs Finds Deficiencies
May 02, 2025 | Chris Kutner | Medicare and Medicaid

The 12 regional Medicare Administrative Contractors (MACs) were recently audited by the U.S. Department of Health and Human Services’ Office of Inspector General (OIG). Each of the MAC jurisdictions was found by the OIG to have failed to meet Medicare cost report oversight requirements in at least one year during…
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It’s more than just the money: The importance of analyzing both economic and noneconomic key issues for a successful health care transaction
April 16, 2025 | Rivkin Rounds Staff | Mergers and Acquisitions

Rivkin Radler’s Norton Travis wrote an article, “It’s More Than Just the Money: The importance of analyzing both economic and noneconomic key issues for a successful health care transaction,” which was published in the April 14 issue of Medical Economics. Sign up to receive Rivkin Rounds at www.RivkinRounds.com. Continue Reading
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Unpacking NY Laboratory Regulations and Recent Enforcement Trends
April 16, 2025 | Rivkin Rounds Staff | Legislation and Public Policy | Uncategorized

On Thursday, April 24, Ada Janocinska and Mary Aperance will present the next installment of Rivkin Radler’s Health Law Executive Briefings, “Unpacking New York Laboratory Regulations and Recent Enforcement Trends.” Ben Malerba will moderate the discussion which will cover the following topics: To register, please click here. The Zoom link…
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23andMe Bankruptcy Raises Legal Concerns Over Genetic Data Privacy
April 11, 2025 | Atara Kahn | Electronic Health Records | Legislation and Public Policy

23andMe’s recent Chapter 11 bankruptcy filing has sparked significant concerns over the privacy and security of genetic data belonging to its 15 million customers. Founded in 2006, 23andMe built its business around direct-to-consumer DNA testing, offering insights into ancestry and health risks. However, declining demand, financial struggles, and a major…
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A Florida jury recently found two laboratory co-owners of Innovative Genomics LLC (“IGX”) not guilty in connection with an allegedly fraudulent COVID-19 testing scheme. The Government alleged that from November 2019 through June 2023, the co-owners conspired to defraud Medicare and the Health Resources and Services Administration COVID-19 Uninsured Program…
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ADA Joins Coalition Seeking Tariff Exemption for Medical and Dental Supplies
April 04, 2025 | Sean Simensky | Dentistry | Legislation and Public Policy | Medical Devices and Wearables

The American Dental Association (ADA) has joined a coalition of other healthcare organizations in writing a letter to U.S. Trade Representative Jamieson Greer urging the Trump administration to exempt medical and dental supplies, equipment and devices from the President’s newly announced widespread tariffs. The coalition’s letter explained, “Given the important…
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An article in the March 10 issue of Part B News, “In trend, court limits drug rebate AKS charges to easier ‘but-for’ standard,” discussed a recent ruling on the False Claims Act (FCA) implications of the federal Anti-Kickback Statute (AKS). Rivkin Radler’s Jeff Kaiser was quoted in the article. “Every time…
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After deported M.D. case, keep alien providers safe, especially if they travel
April 02, 2025 | Rivkin Rounds Staff | Uncategorized

An article in the March 27 issue of Part B News, “After deported M.D. case, keep alien providers safe, especially if they travel,” discussed potential concerns for U.S. medical practices that employ foreign nationals. Rivkin Radler’s Henry Mascia was quoted in the article. Henry said he has not seen immigration…
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NYS Reinforces Its Scrutiny Over Healthcare Transactions
March 27, 2025 | Norton Travis and Jeffrey Ehrhardt | Legislation and Public Policy | Mergers and Acquisitions

Overview We recently discussed increasing state regulation of healthcare mergers and acquisitions in the face of the current Administration’s clear policy of federal deregulation. We noted that 15 states had implemented oversight laws for healthcare transactions. The stated purpose of these laws is to address two key issues: (1) to…
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CTA Obligations for U.S. Companies Are No More
March 27, 2025 | Stella Lellos and Lindsay Brocki | Legislation and Public Policy

After many years of ups and downs, legal challenges, injunctions and deadline changes, the reporting obligations under the Corporate Transparency Act (CTA) have disappeared… for most. On Friday, March 21, the Financial Crimes Enforcement Network (FinCEN) issued an interim final rule eliminating the requirement that U.S. companies and persons report…
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Quality of Care Considerations in OIG’s Nursing Facility Compliance Guidance
March 25, 2025 | Rivkin Rounds Staff | Legislation and Public Policy | Nursing Homes

Rivkin Radler’s John Queenan, Mary Aperance and Jeff Ehrhardt wrote the article “Quality of Care Considerations in OIG’s Nursing Facility Compliance Guidance” for the spring 2025 issue of USLAW Magazine. Sign up to receive Rivkin Rounds at www.RivkinRounds.com. Continue Reading
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State Laws Target Healthcare Investments as Feds Deregulate
March 25, 2025 | Norton Travis | Legislation and Public Policy | Mergers and Acquisitions

Will the new administration’s federal deregulation be a boon for private equity investment in healthcare providers, or will the states be the “new sheriff in town”? In the short time he has been in office, President Trump has made good on his campaign promises to shrink the roles and staff…
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Lab Operator Convicted in Drug-Testing Scheme
March 24, 2025 | Chris Kutner | Fraud and Abuse | Litigation | Medicare and Medicaid

Conspiracies to rip off the Medicare system are prevalent due to the vast amounts of money flowing through the program. On February 25, Sherif Khalil of Redondo Beach, California man was convicted by a federal jury in Detroit for stealing $4 million from the Medicare program. Khalil conspired with others…
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The Status of Providing Gender-Affirming Care to Minors in NY
March 21, 2025 | Mary Aperance | Legislation and Public Policy | Litigation

In recent months, Executive Orders issued by the current Administration regarding gender-affirming care of minors have been the subject of much debate and litigation. The crux of these lawsuits is largely two Executive Orders: Executive Order 14187 (Protecting Children From Chemical and Surgical Mutilation) and Executive Order 14168 (Defending Women…
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The Evolving Opportunities to Strategically Partner or Sell Your Practice
March 18, 2025 | Rivkin Rounds Staff | Mergers and Acquisitions

On Thursday, March 27, in the next installment of Rivkin Radler’s Health Law Executive Briefings, Rivkin Radler’s Ben Malerba will co-present with Jay Pruzansky and Rich Searles from Merritt Healthcare Advisors. The webinar, “The Evolving Opportunities to Strategically Partner or Sell Your Practice,” will discuss: The program will take place…
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RECENT HEALTH LAW NEWS

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