RECENT HEALTH LAW NEWS


Drug Testing Lab to Pay $27 Million to Resolve FCA Claims
November 06, 2024 | Chris Kutner | False Claims Act | Fraud and Abuse | Litigation | Medicare and Medicaid
One of the nation’s largest urine drug testing laboratories recently settled with the federal government by paying $27 million to resolve alleged violations of the federal False Claims Act (FCA) and state statutes. Precision Toxicology (d/b/a Precision Diagnostics), headquartered in San Diego, allegedly provided medically unnecessary urine drug testing and…
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$68 Million CDPAP Fraud Indictment Unsealed Amidst Industry Changes
October 31, 2024 | Jeffrey Ehrhardt | Fraud and Abuse | Home Health | Litigation | Medicare and Medicaid
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…
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Eight Charged in $68 Million Brooklyn Medicaid Fraud Scheme
October 29, 2024 | Atara Kahn | Fraud and Abuse | Home Health | Litigation | Medicare and Medicaid
Eight individuals associated with two Brooklyn social adult day care centers and a home health care intermediary have been charged in an alleged $68 million Medicaid fraud scheme. The defendants, including owners and staff from Happy Family Social Adult Day Care Inc., Family Social Adult Day Care Inc., and Responsible…
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CA Physician and Practice Resolve FCA Allegations for $3.8 Million
October 23, 2024 | Mary Aperance | False Claims Act | Fraud and Abuse | Litigation | Medicare and Medicaid | Uncategorized
The U.S. Attorney’s Office for the Southern District of California announced on October 11 that Dr. Janette Gray and her former medical practice, The Center for Health & Wellbeing in San Diego, resolved False Claims Act (FCA) allegations by agreeing to pay $3.8 million.  Gray and her practice allegedly billed…
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Court: Mailing Drugs to Patients’ Homes is a Potential Stark Law Violation
October 18, 2024 | Eric Fader and Rivkin Rounds Staff | COVID-19 | Legislation and Public Policy | Litigation | Medicare and Medicaid | Pharmaceuticals
A recently issued federal court opinion confirmed that certain pre-COVID era prescribing restrictions are back in place. In July 2023, a nonprofit advocacy group, Community Oncology Alliance, filed suit against the U.S. Department of Health and Human Services (HHS) regarding provisions of the Stark Law. Stark prohibits physicians from referring…
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OCR Imposes $240,000 Penalty in HIPAA Ransomware Investigation
October 11, 2024 | Ada Janocinska | Cybersecurity | Electronic Health Records | HIPAA | Litigation
The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) imposed a $240,000 civil monetary penalty against Providence Medical Institute in connection with a ransomware attack that revealed vulnerabilities in the Institute’s systems and potential HIPAA violations. The Institute was the victim of a series of ransomware…
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Lab Owner Pleads Guilty to COVID-19 Testing Fraud Scheme
October 09, 2024 | Mary Aperance | COVID-19 | Fraud and Abuse | Litigation
On October 1, the U.S. Attorney’s Office for the Northern District of Illinois announced that Zishan Alvi, the owner of a Chicago laboratory, pleaded guilty to one count of wire fraud for his role in a COVID-19 testing fraud scheme. Alvi pleaded guilty to causing claims to be submitted to…
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New Consumer Protection Laws to Affect NY Healthcare Providers
October 07, 2024 | Ada Janocinska and Atara Kahn | Legislation and Public Policy
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…
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Structuring Your Dental Practice Transaction and Elements of the Purchase Agreement
September 25, 2024 | Douglas Menikheim | Dentistry
In our previous article, we described the due diligence process, including what a buyer would look for in your practice. Once due diligence is under way, the next step is the purchase agreement, which is usually prepared by the buyer’s attorney. A purchase agreement is the main document for the…
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HRSA to J&J: Cease Implementation of New 340B Rebate Model
September 23, 2024 | Mary Aperance | Hospitals | Litigation | Pharmaceuticals
As previously discussed here, Johnson & Johnson (J&J) recently announced its intention to change its 340B Drug Pricing Program discount available to disproportionate share hospital (DSH) Covered Entities on purchases of STELARA and XARELTO. However, the Health Resources and Services Administration (HRSA) notified J&J that its rebate model was contrary…
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Connecticut Dentists Settle Kickback Claims
September 12, 2024 | Sean Simensky | Dentistry | False Claims Act | Fraud and Abuse | Litigation | Medicare and Medicaid
Three Connecticut dental practices, together with their owners, have agreed with the U.S. Attorney’s Office for the District of Connecticut to pay $1.7 million to settle allegations that the practices violated federal and Connecticut False Claims Acts and the federal Anti-Kickback Statute. This and other recent settlements seem to be…
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J&J Announces New Rebate Model for 340B Program, but HRSA Pushes Back
September 09, 2024 | Mary Aperance | Hospitals | Legislation and Public Policy | Pharmaceuticals
On August 23, Johnson & Johnson (J&J) announced changes to its 340B Drug Pricing Program discount available to disproportionate share hospital (DSH) Covered Entities on purchases of two of J&J’s most popular drugs, STELARA and XARELTO. As of October 15, J&J will make a 340B discount on these drugs available…
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Hospital Terminates Employees for Allowing Another to Do Their Jobs
September 06, 2024 | Rivkin Rounds Staff | Cybersecurity | Employer/Employee | HIPAA | Home Health
An article in the September issue of Healthcare Risk Management’s HIPAA Regulatory Alert, “Hospital Terminates Employees for Allowing Another to Do Their Jobs,” discussed a recent incident at Mass General Brigham in Somerville, MA. Upon investigation, the hospital discovered that two employees inappropriately allowed a third person, who was not…
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Radiology Practice to Pay $8.9M to Resolve FCA/AKS Claims
August 30, 2024 | Rivkin Rounds Staff | False Claims Act | Fraud and Abuse | Litigation | Medicare and Medicaid
The U.S. Attorney’s Office for the Southern District of Texas announced on August 20 that National Interventional Radiology Partners PLLC (NIRP) and its founder and CEO will pay $8,884,091 to the United States to resolve alleged violations of the federal False Claims Act (FCA) and Anti-Kickback Statute. NIRP and Dr.…
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CA Dental Offices Pay $6.3M to Resolve FCA Claims 
August 23, 2024 | Sean Simensky | COVID-19 | Dentistry | False Claims Act | Fraud and Abuse | Litigation
West Coast Dental Administrative Services LLC, which operates more than 40 dental and specialist locations in Southern California, and its affiliates have paid $6.3 million to resolve alleged violations of the False Claims Act (FCA). The alleged violations were in connection with loans received by the affiliated offices pursuant to…
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Biotech Company Pays $4.5 Million for Data Breach
August 21, 2024 | Benjamin Wisher | Cybersecurity | Electronic Health Records | Litigation
The Office of the New York State Attorney General announced on August 13 that Letitia James, along with the Attorneys General of Connecticut and New Jersey, fined Enzo Biochem, Inc. $4.5 million for failing to adequately safeguard its patients’ health data. Enzo conducts drug research and development, and provides diagnostic…
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Enforcement Trends Impacting the Drug and Device Industries
August 16, 2024 | Rivkin Rounds Staff | FDA | Fraud and Abuse | Legislation and Public Policy | Medical Devices and Wearables | Pharmaceuticals
On September 19, Rivkin Radler’s Jeff Kaiser will participate on a panel at Practising Law Institute’s “Life Sciences 2024: Navigating Legal Challenges in Drug and Device Industries” program in New York City. Held at PLI’s NY Conference Center at 1177 Avenue of the Americas and also available to view online,…
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Medical Provider to Pay $115,200 Penalty for HIPAA Right of Access Violation
August 16, 2024 | Ada Janocinska | Electronic Health Records | HIPAA | Litigation
The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) recently announced that it ordered American Medical Response (AMR) to pay a civil monetary penalty of $115,200 for failing to comply with the patient right of access rule under HIPAA. HIPAA requires that all covered entities provide…
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Know When to Bill Facility Fee for Telehealth Services!
August 06, 2024 | Chris Kutner | Behavioral Health | False Claims Act | Fraud and Abuse | Hospitals | Litigation | Medicare and Medicaid | Nursing Homes | Telehealth
The U.S. Attorney’s Office for the District of Connecticut recently announced that Supportive Care Holdings, LLC and its related companies agreed to pay the federal government nearly $4,600,000 to resolve allegations of submitting false claims. The Supportive Care companies provide behavioral health services via telehealth to patients residing in skilled…
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NY Court Finds Unlawful Fee Splitting in Practice Acquisition
July 31, 2024 | Benjamin Malerba | Dentistry | Legislation and Public Policy | Litigation
The prohibition on fee splitting by professionals is alive and well in New York. The sale of a dental practice from one dentist to another was found to violate the state’s prohibition against fee splitting because the purchase price was to be paid, in part, based on a percentage of the…
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NJ Biopharma Company Settles FCA/AKS Case for $5M+
July 25, 2024 | Eric Fader | False Claims Act | Fraud and Abuse | Litigation | Medicare and Medicaid | Pharmaceuticals
The U.S. Department of Justice announced on July 24 that Admera Health LLC, a New Jersey-based biopharmaceutical research and clinical laboratory testing company, agreed to pay $5,389,648 to resolve kickback allegations brought by two whistleblowers under the False Claims Act (FCA). Admera provides biopharmaceutical research services for healthcare institutions and…
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OCR Announces Third Ransomware Settlement as Threats Continue to Rise
July 24, 2024 | Ashley Algazi | Cybersecurity | Electronic Health Records | HIPAA | Hospitals | Litigation
On July 1, the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) announced that Heritage Valley Health System, a provider in Pennsylvania, Ohio and West Virginia, agreed to pay $950,000 to resolve potential violations of the HIPAA Security Rule. Heritage Valley’s alleged violations included failure to…
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FTC Bans Non-Competes: What It Means for You
July 17, 2024 | Rivkin Rounds Staff | Employer/Employee | Legislation and Public Policy
The Federal Trade Commission (FTC) recently enacted a regulation that would effectively ban non-compete agreements for almost all employers. Unless the rule is blocked by legal challenges, it will take effect on September 4. Long Island Business News hosted a webinar on June 26, which explored the ban’s viability. Ken…
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HHS OIG Issues Information-Blocking Disincentives for Certain Health Care Providers
July 09, 2024 | Benjamin Malerba and Jeffrey Ehrhardt | Electronic Health Records | Hospitals | Legislation and Public Policy | Medicare and Medicaid
On June 24, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) announced a final rule that establishes disincentives for certain health care providers that have committed information blocking, or any activity that is likely to hamper access, exchange, or use of electronic protected health information (PHI).…
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AG Garland Announces Nationwide Healthcare Enforcement Action
July 08, 2024 | Jeff Kaiser | Fraud and Abuse | Litigation | Medicare and Medicaid | Pharmaceuticals | Telehealth
On June 27, U.S. Attorney General Merrick Garland announced the results of a two-week nationwide law enforcement action by the Department of Justice (DOJ) in 32 federal districts against 193 defendants for their participation in a variety of healthcare fraud schemes. These federal enforcement actions also included the seizure of more…
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Fader Co-Authors Article, Presents Podcast on Neuromonitoring “Surgeon Deals”
June 27, 2024 | Rivkin Rounds Staff | Fraud and Abuse | Hospitals | Legislation and Public Policy | Medicare and Medicaid | Private Insurers
Rivkin Radler Partner Eric Fader co-authored an article in the March-April issue of SpineLine, the magazine of the North American Spine Society (NASS). The article, “OIG Advisory Opinion Cautions Against ‘Surgeon Deals’ in Neuromonitoring,” was written with Rich Vogel, PhD, DABNM, FASNM, the current President of the American Society of…
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CT New Law Alert: Medical Debt Cannot be Reported to Credit Agencies
June 13, 2024 | Ada Janocinska | Legislation and Public Policy
Connecticut Governor Ned Lamont recently signed a new bill into law that prohibits healthcare providers from reporting patients’ medical debt to credit rating agencies. The law goes into effect on July 1, 2024. In addition, any contracts signed by healthcare providers with credit rating agencies on or after July 1,…
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Must You Rehire Suspended Providers Who Get Their License Back? Look to Contract
June 10, 2024 | Rivkin Rounds Staff | Employer/Employee
A May 20 article in Part B News, “Must You Rehire Suspended Providers Who Get Their License Back? Look to Contract,” discussed whether an employer must rehire a suspended provider who gets his or her license back. Rivkin Radler’s Chris Kutner was quoted in the article. Chris said that the…
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Conducting HIPAA Breach Assessments and Disclosures: Requirements and Tips for Success
May 29, 2024 | Rivkin Rounds Staff | Cybersecurity | Electronic Health Records | HIPAA | Legislation and Public Policy
On Thursday, June 13, in the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler partner Ashley Algazi will present ”Conducting HIPAA Breach Assessments and Disclosures: Requirements and Tips for Success.”  The program will take place from 12:00 noon to 1:00 PM Eastern time via Zoom.…
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MA Hospital Pays $24 Million to Settle FCA Case
May 29, 2024 | Mary Aperance | False Claims Act | Fraud and Abuse | Hospitals | Litigation | Medicare and Medicaid
On May 16, the U.S. Attorney’s Office for the District of Massachusetts announced that Cape Cod Hospital agreed to pay $24.3 million to resolve alleged violations of the federal False Claims Act (FCA) for knowingly failing to follow Medicare’s requirements for certain procedures performed. Beginning in 2015, the hospital offered…
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Guilty Plea in $50 Million Medicare Fraud Scheme
May 16, 2024 | Rivkin Rounds Staff | Fraud and Abuse | Litigation | Medicare and Medicaid | Pharmaceuticals
Manishkumar Patel of Pelham Manor, NY recently pleaded guilty in connection with a healthcare fraud and kickback scheme involving the sale of fraudulent prescriptions to pharmacies, durable medical equipment suppliers, and laboratories, which then obtained payments from Medicare. The scheme resulted in $50 million in fraudulent claims from 2019-22. Patel…
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Billing for Unsupervised PAs Leads to $2 Million Settlement
May 14, 2024 | Mary Aperance | Employer/Employee | False Claims Act | Fraud and Abuse | Litigation | Medicare and Medicaid
The U.S. Attorney’s Office for the Eastern District of Michigan announced on May 8 that Michigan Ear Care PLLC and James Aronovitz, D.O. agreed to pay over $2 million to resolve allegations that they submitted false claims to the Medicare and Medicaid programs. Aronovitz allegedly billed for ear care services…
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Lab Owner Pleads Guilty in Covid Test Kit Fraud Scheme
May 08, 2024 | Rivkin Rounds Staff | COVID-19 | Fraud and Abuse | Litigation | Medicare and Medicaid
Robert Clark of Pompano Beach, Florida recently pleaded guilty to his role in a Medicare fraud scheme. Clark and his co-conspirators purchased Medicare Beneficiary Identification numbers unlawfully and then billed Medicare for over-the-counter COVID-19 test kits. The conspirators also paid illegal kickbacks and bribes to marketers for referring Medicare beneficiaries…
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Owner and Medical Director of Pain Clinic Jailed for Urine Drug Testing Scheme
May 07, 2024 | Mary Aperance | Fraud and Abuse | Litigation | Medicare and Medicaid
On April 11, the medical director and the owner of a pain clinic in Kentucky were sentenced to prison for their roles in a scheme to defraud federal healthcare programs and commercial insurance companies for medically unnecessary urine drug testing. Previously, in March 2023, the clinic’s medical director, William Lawrence…
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FTC Issues New Rule to Abolish Non-Compete Agreements
April 29, 2024 | Nancy Del Pizzo and Tim Gonzalez | Employer/Employee | Legislation and Public Policy
On Tuesday, April 23, the Federal Trade Commission (FTC) issued a final rule designed to promote competition and new business formation that, when effective, will impose a nationwide ban on non-compete agreements across all industries. Existing non-compete agreements for employees will become unenforceable. Existing non-competes for senior executives can remain…
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NP Gets Jail Time for DME Fraud Scheme
April 26, 2024 | Mary Aperance | Fraud and Abuse | Litigation | Medical Devices and Wearables | Medicare and Medicaid | Telehealth
On April 10, Virginia-based nurse practitioner Daphne Jenkins was sentenced to prison for her participation in a $7.8 million telemedicine fraud scheme that involved medically unnecessary orders for durable medical equipment (DME). As part of the scheme, Medicare claims were submitted based on false documentation and tainted by kickbacks.   The…
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NYS Maintains Independent Practice Authority for NPs
April 22, 2024 | Jeffrey Ehrhardt and Eric Fader | Legislation and Public Policy
The New York State 2024-2025 budget includes legislation that extends until July 1, 2026 the independent practice authority for certain qualified nurse practitioners with over 3,600 practice hours.  Our prior post on this topic provides additional details on which nurse practitioners qualify to practice independently, that is, without a written…
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Defending Provider Audits
April 05, 2024 | Rivkin Rounds Staff | Litigation | Medicare and Medicaid | Private Insurers
On Thursday, April 11, in the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler’s Bob Hussar, Chris Kutner and Mary Aperance will present “Defending Provider Audits.”  The program will take place from 12:00 noon to 1:00 PM Eastern time via Zoom. The program will cover…
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Patient and Family Complaints Require Careful Response
April 05, 2024 | Rivkin Rounds Staff | Litigation | Uncategorized
An article in the April issue of Healthcare Risk Management, “Patient and Family Complaints Require Careful Response,” highlights ways that healthcare organizations can address patient and family complaints in a professional and courteous way to avoid further escalation. Rivkin Radler partner Eric Strober was quoted in the article. “Healthcare professionals should…
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Federal Rules Limit “Junk” Health Plans
April 05, 2024 | Ada Janocinska | Affordable Care Act | Legislation and Public Policy | Private Insurers
On March 28, the U.S. Departments of Health and Human Services, Labor and the Treasury collectively issued final rules with respect to short-term and limited duration insurance (STLDI) plans in an effort to reduce healthcare costs by protecting consumers from purchasing such “junk” health plans that may provide little to…
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Rivkin Radler to Exhibit and Present at Greater Long Island Dental Meeting
April 01, 2024 | Rivkin Rounds Staff | Dentistry
Rivkin Radler’s Dental Practice Counseling Group will be exhibiting and presenting at the Greater Long Island Dental Meeting from April 2-3 at the Melville Hilton. “Practice Transitions for the Practicing Dentist” will be presented by Ben Malerba, Doug Menikheim, Joel Greenberg, Eric Ploumis, and Sean Simensky on Tuesday, April 2 from…
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FDA Sends a Message with Two Warning Letters to Amazon
April 01, 2024 | Rivkin Rounds Staff | FDA | Legislation and Public Policy | Pharmaceuticals
Marc S. Ullman, of counsel to Rivkin Radler, wrote the March 28 article “FDA sends a message with two warning letters to Amazon” in Natural Products Insider. In the article, Marc explains the importance of the FDA warning letters on homeopathic “supplements” and products that contain active pharmaceutical ingredients. Marc writes,…
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NY Joins List of States Prohibiting Geofencing Near Healthcare Facilities
March 29, 2024 | Rivkin Rounds Staff | Cybersecurity | HIPAA | Hospitals | Legislation and Public Policy
Rivkin Radler’s Frank Izzo and Jeff Ehrhardt authored an article in the Spring 2024 issue of USLAW magazine, “New York Joins List of States Prohibiting Geofencing Near Healthcare Facilities.” The article discussed geofencing laws, enacted partly in response to the Supreme Court Dobbs decision, in depth by state. Sign up…
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NJ LCSW Pleads Guilty to Defrauding Private Health Insurers for Years
March 29, 2024 | Tim Gonzalez | Behavioral Health | Fraud and Abuse | Litigation | Private Insurers
The owner of Bergen Alliance Counseling Services in Paramus, New Jersey pleaded guilty to a run-of-the-mill healthcare fraud scheme in District Court in Newark on March 19. Maria Cosentino of Garfield, a licensed clinical social worker, admitted to billing private healthcare programs for counseling sessions that did not take place.…
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NY Acupuncturist Pleads Guilty to Conspiracy to Commit Health Care Fraud in NJ
March 28, 2024 | Tim Gonzalez | Fraud and Abuse | Litigation
A New York acupuncturist recently admitted to billing Amtrak’s health care benefit plan for services that were never provided and were medically unnecessary. From January 2019 through June 2022, Punson Figueroa of Long Island City, New York paid Amtrak employees hundreds of thousands of dollars in cash kickbacks in order…
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