RECENT HEALTH LAW NEWS

Medicaid Fraud Enforcement Reminder for Dental Practices
October 30, 2026 | Sean Simensky | Dentistry | Fraud and Abuse | Medicare and Medicaid

Federal and state authorities continue to scrutinize billing practices in the dental industry. In a recent case, Steven A. Price, a Washington, D.C. dentist, was sentenced to 24 months in prison after being convicted in connection with a scheme that defrauded D.C. Medicaid. Price was sentenced to 24 months in…
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NY Dentist Accused of Medicaid Fraud
October 30, 2026 | Sean Simensky | Dentistry | Fraud and Abuse

According to a September 28 report on News 12 Long Island, Hicksville dentist Suleman Nasimi and his Queens practice, Tooth Fresh Meadows, face felony charges arising from allegations that Medicaid paid more than $300,000 for dental services from January 2020 through August 2024 that were not provided. Prosecutors allege that…
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DOJ and HHS Coordinate Self-Disclosure Policies
October 22, 2026 | Jeff Kaiser | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid

On October 15, Assistant Attorney General Colin M. McDonald issued a Memo announcing new coordination between the National Fraud Enforcement Division (NFED) and the U.S. Department of Health and Human Services Office of Inspector General (OIG) regarding self-disclosure in criminal health care fraud matters.[1] The Memo notes that in the…
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California Expands Oversight of Private Equity Transactions
October 20, 2026 | Norton Travis | Legislation and Public Policy | Mergers and Acquisitions

As previously discussed here, a growing number of states are increasing oversight and regulation of healthcare transactions involving private equity (PE), hedge funds and other investors, as well as agreements between management services organizations (MSOs) and physician groups. The stated rationales for such oversight are concerns over quality of patient…
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Earlier this month, an owner of Brooklyn-based Happy Family Social Adult Day Care Center, Inc., Family Social Adult Day Care Center, Inc. and Responsible Care Staffing, Inc., a home health care fiscal intermediary operating under the Consumer Directed Personal Assistance Program (CDPAP), pleaded guilty to defrauding Medicaid of approximately $65…
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DOH Updates Nursing Home Incident Reporting Manual: What Operators Should Know
October 08, 2026 | Marc Antonucci | Nursing Homes

The New York State Department of Health (DOH) recently issued Dear Administrator Letter DRS 26-05 announcing the release of an updated Nursing Home Incident Reporting Manual. Nursing home operators should review the updated manual to confirm that their incident reporting policies, investigation practices, documentation tools, escalation protocols, and staff training…
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National Fraud Enforcement Division Issues Guidance for Corporate Fraud Enforcement
October 08, 2026 | Jeff Kaiser | Fraud and Abuse | Legislation and Public Policy

On October 1, Assistant Attorney General Colin M. McDonald issued a memo on “Corporate Enforcement in the Fight Against Fraud” (the “Memo”), announcing an “all-tools approach to investigating and prosecuting our health care, government, tax, and trade fraud priorities.”[1] The Memo includes directives to ensure that the National Fraud Enforcement…
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$500 Million Fraud Case Highlights Continued Scrutiny of COVID-19 Testing
October 05, 2026 | Ada Janocinska | COVID-19 | Fraud and Abuse | Litigation

The U.S. Department of Justice (DOJ) announced on September 24 that the Chief Operating Officer of Fast Lab Technologies, LLC pleaded guilty to conspiracy to commit healthcare fraud in connection with a nationwide COVID-19 billing scheme that resulted in more than $500 million in fraudulent claims. According to DOJ, the…
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Cigna and OpenAI Collaborate on AI Support for Cancer Care
October 05, 2026 | Atara Kahn | Artificial Intelligence | Private Insurers

On September 23, the Cigna Group announced a collaboration with OpenAI to develop more personalized support for patients with complex conditions, initially focusing on cancer care. The initiative will integrate OpenAI’s artificial intelligence capabilities into Cigna’s clinical workflows and patient-facing services. One of the first planned capabilities would help oncology…
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DOJ Issues Updated Guidance Affecting FCA Prosecutions
September 30, 2026 | Jeff Kaiser | False Claims Act | Legislation and Public Policy | Litigation

This month, the U.S. Department of Justice (DOJ) made revisions to the Justice Manual in two areas affecting False Claims Act (FCA) prosecutions: (1) the use of sub-regulatory guidance; and (2) DOJ’s exercise of its dismissal authority. Sub-Regulatory Guidance One of the revisions “reinstates and builds upon” polices set forth…
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Second Circuit Confirms No Private Right of Action under NSA to Enforce IDR Awards
September 29, 2026 | Emily Manning | Litigation | Private Insurers

On September 17, the U.S. Court of Appeals for the Second Circuit reaffirmed that the No Surprises Act (NSA) does not provide out-of-network providers with a private right of action to enforce payment determinations issued through the independent dispute resolution (IDR) process. The plaintiff in East Coast Advanced Plastic Surgery,…
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National Fraud Enforcement Division Makes Home Care Fraud a Priority
September 24, 2026 | Jeff Kaiser | Fraud and Abuse | Home Health | Legislation and Public Policy

In August, Assistant Attorney General Colin McDonald issued a memorandum (the “Memo”) announcing the enforcement priorities of the National Fraud Enforcement Division (also known as NFED), which the U.S. Justice Department (DOJ) established in April of this year.[1] McDonald noted that NFED “has quickly established a nationwide footprint” since…
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“Stop Corporate Takeovers of Physicians Act”: Federal Bill Targets Corporate Control of Physician Practices and MSO Arrangements
September 24, 2026 | Douglas Menikheim | Legislation and Public Policy | Mergers and Acquisitions

A newly introduced federal bill aimed at prohibiting the corporate practice of medicine, titled the “Stop Corporate Takeovers of Physicians Act,” was introduced on September 16 by several Democratic lawmakers in the Senate and House. The bill would impose sweeping restrictions on corporate ownership and control of medical practices and…
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11th Circuit Court of Appeals Joins Sister Circuits in Holding FCA Constitutional
September 23, 2026 | Jeff Kaiser | False Claims Act | Litigation | Medicare and Medicaid

Earlier this month, the 11thh Circuit Court of Appeals joined the 5th, 6th, 9th and 10th Circuits in holding that the qui tam provisions of the False Claims Act (FCA) do not violate the Appointments Clause of the United States Constitution. The case, United States ex rel. Zafirov v. Fla.…
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Medicare Exclusions Not Just for OIG Anymore
September 20, 2026 | Rivkin Rounds Staff | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid

An article in the September 17 issue of Part B News, “Medicare exclusions not just for OIG anymore: RFK Jr.,” discussed various types of possible disciplinary actions against Medicare providers. Rivkin Radler’s Chris Kutner was quoted in the article. “I don’t think there’s a percentage of the population that really understands…
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Private Equity Dealmaking Slows in 2026
August 28, 2026 | Norton Travis | Legislation and Public Policy | Mergers and Acquisitions

We have been reporting regularly on the increasing role that private equity has been playing in the healthcare industry and the oversight initiatives that a number of states have taken to address certain concerns resulting from this trend. In a just-published article, Modern Healthcare cites data from Pitchbook and reports…
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Two Long Island ophthalmology practices have agreed to return $2.3 million in payments from state and federal government programs based on the ordering of unnecessary trans-cranial doppler ultrasounds (TCDs). The lawsuit brought by a whistleblower under the False Claims Act (FCA) against Mark D. Fromer, P.C., dba Fromer Eye Centers,…
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On September 17, Rivkin Radler’s Jeff Kaiser will participate on a panel at the Practising Law Institute (PLI) “Life Sciences 2026: Navigating Legal Challenges in Drug and Device Industries” program in New York City. The panel is entitled “Enforcement Trends Impacting the Drug and Device Industries.” Offered virtually and at…
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NY Medicaid Revalidation and Enrollment Moratorium: Immediate Planning Considerations for Providers
August 20, 2026 | Marc Antonucci | Legislation and Public Policy | Medicare and Medicaid

New York Medicaid providers should prepare now for significant changes in provider enrollment oversight. The New York State Department of Health (DOH), following direction from the Centers for Medicare & Medicaid Services (CMS), will require every Medicaid-enrolled provider in New York to complete revalidation over the next 24 months. The…
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With the New York Medicaid Program facing scrutiny by the U.S. Department of Health and Human Services (HHS) for a perceived lack of oversight and compliance integrity involving certain types of providers (including personal care and home health providers), the New York Department of Health (DOH) recently announced certain program…
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OIG Advisory Opinion: “Food-as-Medicine” Program Presents Low Fraud and Abuse Risk
August 14, 2026 | Jeffrey Rust | Fraud and Abuse | Legislation and Public Policy | Medicare and Medicaid

The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently issued Advisory Opinion 26-16, concluding that the “food-as-medicine” program operated by a federally qualified health center, which provides weekly produce boxes or vouchers paired with periodic health assessments for financially needy patients with diabetes or hypertension,…
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FTC and States Sue Hims & Hers Over Privacy and Billing Practices
August 13, 2026 | Ada Janocinska | Litigation | Pharmaceuticals | Telehealth

The Federal Trade Commission (FTC), joined by the States of California and Utah, has filed a lawsuit against telehealth company Hims & Hers, alleging that the company engaged in deceptive privacy, billing, and subscription practices. According to the lawsuit, Hims & Hers shared consumers’ health information with third-party advertising companies,…
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VT Limits PE Involvement with Healthcare Providers
August 07, 2026 | Norton Travis and Emily Manning | Legislation and Public Policy | Mergers and Acquisitions

We have previously reported that a number of states have proposed legislation to address growing concerns about the potential negative impacts of private equity (PE) investments in healthcare businesses. Vermont has now joined this list by passing legislation on June 15 (H.583, “An act relating to clinical decision making”) that…
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NY’s MAID Law: Updates that Medical Providers and Facilities Should Know
July 31, 2026 | Marc Antonucci and Jeffrey Ehrhardt | Legislation and Public Policy

As discussed in our prior publication, Medical Aid in Dying Is Now Legal in NY, Gov. Kathy Hochul signed New York’s Medical Aid in Dying Act (MAID) on February 6, 2026. Since then, the New York State Department of Health (DOH) has issued a form (DOH-5847) for patients to request MAID,…
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On July 1, 2026, the Centers for Medicare & Medicaid Services (CMS) proposed a new rule that included certain enrollment-related policy changes under the Home Health Prospective Payment System (HHPPS) designed to “reduce improper Medicare payments and protect beneficiaries.”[1] As explained by CMS, “[t]he overarching purpose of the enrollment process…
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Heads Up: New No Surprises Rule May Block Some IDR Claims
July 20, 2026 | Rivkin Rounds Staff | Legislation and Public Policy | Private Insurers

An article in the June 25 issue of Part B News, “Heads up: New No Surprises rule mayblock some IDR claims,” discussed the No Surprises Act’s recently effective final rule. Rivkin Radler’s Chris Kutner was quoted in the article. The final rule affects how healthcare providers file independent dispute resolution (IDR)…
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Ambulette Company Owners Charged in Fraud Scheme
July 16, 2026 | Chris Kutner | Fraud and Abuse | Litigation | Medicare and Medicaid

Two New York residents were recently indicted in the Eastern District of New York federal court in Central Islip for conspiracy to commit healthcare fraud, among other charges. The defendants allegedly paid kickbacks and submitted fraudulent claims to government payors, including Medicaid, for transportation services that were either not provided…
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Carbon Health Settlement Highlights Scrutiny of MSOs
July 09, 2026 | Norton Travis and Atara Kahn | Litigation | Mergers and Acquisitions

California Attorney General Rob Bonta recently announced a proposed settlement with Carbon Health Technologies, Inc., which operates primary care clinics throughout the state. The settlement follows allegations that the company’s physician practice management structure ran afoul of California’s corporate practice of medicine (CPOM) doctrine, as well as certain state consumer…
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Resolving Payment Disputes Under the No Surprises Act
July 08, 2026 | Rivkin Rounds Staff | Legislation and Public Policy | Litigation | Private Insurers

On Thursday, July 23, in the next installment of Rivkin Radler’s Health Law Executive Briefings, Chris Kutner and Emily Manning will present “Resolving Payment Disputes Under the No Surprises Act: An Analysis of the Federal IDR Process.” The federal Independent Dispute Resolution (IDR) process, administered by the U.S. Department of…
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OIG Green-Lights Free Testing by Pharmaceutical Manufacturer
June 30, 2026 | Ada Janocinska | Fraud and Abuse | Legislation and Public Policy | Pharmaceuticals

The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently issued a favorable Advisory Opinion (No. 26-14) to a pharmaceutical manufacturer that is proposing to offer free antibody testing to patients. In the proposed arrangement, the manufacturer would offer free antibody testing to determine whether patients…
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NYS Hospitals, Nursing Homes Must Adopt Violence Prevention Programs
June 26, 2026 | Marc Antonucci and Jeffrey Ehrhardt | Hospitals | Legislation and Public Policy | Nursing Homes

New workplace safety mandates are on the horizon for certain New York healthcare providers. Under recently enacted Public Health Law section 2832, covered facilities – defined as general hospitals and nursing homes – must establish workplace violence prevention programs by September 18, 2027. In addition, general hospitals must conduct annual…
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DOJ Sues New York and PPL Over Alleged Fraud in Revamping CDPAP Program
June 23, 2026 | Jeff Kaiser | Fraud and Abuse | Litigation | Medicare and Medicaid

On June 16, The Department of Justice (DOJ) sued the New York Department of Health (DOH), the DOH Medicaid Director, and Public Partnerships LLC (PPL) – the Georgia-based company selected by DOH in 2025 to manage New York’s Consumer Directed Personal Assistant Program (CDPAP) – in federal district court. The…
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American College of Physicians Issues Position Paper on Private Equity in Healthcare
June 19, 2026 | Norton Travis | Mergers and Acquisitions

The American College of Physicians (ACP) recently issued a new position paper entitled “Regulatory Framework for Private Equity and Corporatization in Health Care” that examines the impact of private equity on healthcare costs, access, equity, innovation, and clinical autonomy. The ACP is the largest specialty organization in the U.S., with…
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HHS Finalizes Major Reforms to IDR Process under NSA
June 04, 2026 | Joel Greenberg | Legislation and Public Policy | Litigation | Private Insurers

On May 28, the U.S. Department of Health and Human Services (HHS) finalized regulations intended to make the Independent Dispute Resolution (IDR) process under the No Surprises Act (NSA) more efficient and transparent in helping to resolve out-of-network payment disputes between healthcare providers and payors. Under the IDR process, insurers…
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Aspen Dental, one of the nation’s largest dental service organizations (DSOs), recently settled charges alleging violations of California’s corporate practice of medicine (CPOM) and unfair competition laws. This was not the first time similar charges had been lodged against Aspen Dental; in 2015, it entered into a settlement with the…
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On May 27, in furtherance of the March 16, 2026 Executive Order on Eliminating Fraud, Assistant Attorney General Brett A. Shumate issued a memo titled “Accelerating Review and Enhancing Enforcement in Benefits Fraud Matters.” The Memo announced new measures by the U.S. Department of Justice (DOJ) to strengthen False Claims…
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Health care providers may want to offer free or discounted services to help patients, and that instinct may be good. Most providers, however, don’t think of “free care” as a kickback issue in the same way they might think about gifts or rewards as a kickback issue. They should, because…
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The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) recently issued a favorable Advisory Opinion (No. 26-09) regarding certain free treatment that would be offered to patients of a pediatric dental clinic. Specifically, the clinic planned to offer free comprehensive orthodontic treatment to one select patient…
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The U.S. Department of Justice (DOJ) recently announced a new initiative to enhance its working relationship with data miners who bring cases as whistleblowers under the False Claims Act (FCA). The initiative is dubbed “FOCUS,” an acronym for Fraud Oversight through Careful Use of Statistics. There has been a sharp…
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Overview of the Federal IDR Process
May 21, 2026 | Emily Manning | Legislation and Public Policy | Litigation | Private Insurers

[Note: On May 28, HHS finalized new regulations on the IDR process, as discussed here.] The No Surprises Act (NSA), enacted in 2020, was designed to protect patients from unexpected medical bills in certain healthcare settings. The law primarily applies when a patient receives emergency care at either an in-network…
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NJ Pharmacy Exec Jailed for Kickback Scheme
May 14, 2026 | Syma Levine | Fraud and Abuse | Litigation | Pharmaceuticals

Adam Brosius, a former pharmacy executive, was recently sentenced to 24 months in prison and ordered to pay $33 million in restitution and $27 million in forfeiture. Brosius was the director and then the president of Main Avenue Pharmacy, a mail-order pharmacy based in Clifton, New Jersey. He orchestrated a…
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On Thursday, May 28, in the next installment of Rivkin Radler’s Health Law Executive Briefings, Ashley Algazi and Tim Gonzalez will present “Examining AI in Health Care: A Review of Key Strategic, Legal, and Regulatory Considerations.” As AI technologies become more integrated into clinical, operational, and administrative functions, health care…
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The U.S. Food and Drug Administration (FDA) recently approved Eli Lilly and Company’s oral GLP-1 receptor agonist, Foundayo (orforglipron), for chronic weight management in adults with obesity or those who are overweight with at least one weight-related condition. The approval introduces a new oral treatment option in a space that…
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On April 21, in a “Hearing on Protecting Patients and Taxpayers: Cracking down on Medicare Fraud,” the House Ways & Means Committee received testimony on hospice and home health fraud from Sheila Clark, President and Chief Executive Officer of the California Hospice and Palliative Care Association,[1] and Chris Deery, the…
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Understanding Medicare Revalidation Requirements
April 23, 2026 | Emily Manning | Legislation and Public Policy | Medicare and Medicaid

In accordance with 42 C.F.R. § 424.515, all healthcare providers participating in Medicare are required to periodically revalidate their enrollment records with the Centers for Medicare & Medicaid Services (CMS) in order to maintain Medicare billing privileges. This routine process requires providers to confirm and, if necessary, update their enrollment information.…
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RECENT HEALTH LAW NEWS

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