RECENT HEALTH LAW NEWS

Provider and Beneficiaries Conspired to Defraud Louisiana’s Medicaid Program
March 05, 2025 | Chris Kutner | False Claims Act | Litigation | Medicare and Medicaid

Healthcare fraud is prevalent within state Medicaid programs due to the massive amounts of money flowing through the system. In Louisiana, the Estate of Yolanda Burnom and her former company, Community Healthcare Solutions, LLC, recently agreed to pay $4.6 million to settle a False Claims Act lawsuit. The allegations included…
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TRICARE Administrator Pays $11 Million Under FCA for Cybersecurity Noncompliance
February 28, 2025 | Benjamin Wisher | Cybersecurity | False Claims Act | Litigation

The U.S. Department of Justice (DOJ) announced on February 18 that Health Net Federal Services, LLC and its corporate parent, Centene Corporation, agreed to pay $11,253,400 to resolve False Claims Act (FCA) claims. Health Net, a federal contractor responsible for administering TRICARE, allegedly falsely certified compliance with cybersecurity requirements in…
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DMERx, an online DME platform, served as the basis for a massive fraud against Medicare and other insurers. Gregory Schreck, a Kansas man who was the vice president of DMERx, orchestrated a sophisticated fraud scheme to bill Medicare and other insurers over $1 billion, resulting in payments of over $350…
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CTA: Clear Deadline, Unclear Future
February 24, 2025 | Stella Lellos and Lindsay Brocki | Legislation and Public Policy

[THIS INFORMATION HAS BEEN SUPERSEDED] The Financial Crimes Enforcement Network (FinCEN) has announced that beneficial ownership information (BOI) reporting requirements under the Corporate Transparency Act (CTA) are once again back in effect and the new deadline for most businesses to report is March 21, 2025. While businesses should be prepared to comply with…
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On January 29, the New York State Office of the Medicaid Inspector General (OMIG) published its 2025 Work Plan, which provides a preview of the OMIG’s program integrity initiatives for the upcoming year. While this post highlights several areas that the OMIG will focus on, Medicaid providers should refer to…
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Welcome to the ICE Age—A New Era of Immigration Enforcement
February 14, 2025 | Rivkin Rounds Staff | Legislation and Public Policy | Uncategorized

On Thursday, February 27, in the next installment of Rivkin Radler’s Health Law Executive Briefings, Partners Melissa Dearing, Henry Mascia and Ben Malerba will present “Welcome to the ICE Age—A New Era of Immigration Enforcement.” The presentation will focus on: The program will take place from 12 noon to 1…
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DEA Announces New Telemedicine Rules Expanding Access to Controlled Substances
February 09, 2025 | Atara Kahn | Legislation and Public Policy | Pharmaceuticals | Telehealth

On January 16, the U.S. Drug Enforcement Administration (DEA) announced three new telemedicine rules that extend prescribing flexibilities for controlled substances, following the expiration of temporary flexibilities granted during the COVID-19 pandemic. The new rules, which include both final and proposed regulations, aim to balance patient access with safeguards against…
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The U.S. Department of Justice announced on January 15 that Jeffrey Paul Madison, the former chief executive officer of a Texas hospital, was sentenced to 36 months in federal prison for conspiring to violate the federal Anti-Kickback Statute (AKS). In October 2024, Madison also agreed to pay over $5.3 million…
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SCOTUS Hands Down CTA Decision — FinCEN Says Reporting Requirements Remain on Pause
January 24, 2025 | Stella Lellos and Lindsay Brocki | Legislation and Public Policy

The Financial Crimes Enforcement Network (FinCEN) announced on Friday, January 24, that reporting companies are not currently required to file beneficial ownership information (BOI) under the Corporate Transparency Act (CTA). Despite the recent decision by the Supreme Court of the United States (“SCOTUS”) to overturn the nationwide injunction of the CTA in connection with…
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The U.S. Department of Justice (DOJ) recovered $2.9 billion under the False Claims Act (FCA) in 2024, a 5% bump from 2023. This total represents the most recovered since 2021 and reaffirms the FCA’s central role in the government’s anti-fraud efforts. The DOJ entered 558 FCA settlements and judgments, the…
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Some COVID-Era Medicare Telehealth Waivers Extended through March 31
January 16, 2025 | Eric Fader | Legislation and Public Policy | Medicare and Medicaid | Telehealth

The American Relief Act, 2025, signed into law on December 21, included a short-term extension of certain telehealth waivers that went into effect in the early days of the COVID-19 Public Health Emergency. These waivers, for telehealth services provided to Medicare beneficiaries, had been set to expire on December 31,…
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2025 Healthcare Mergers & Acquisitions: What To Expect; How To Prepare; Choosing The Right Deal
January 13, 2025 | Rivkin Rounds Staff | Dentistry | Hospitals | Uncategorized

2025 promises to see a significant increase in the volume of healthcare mergers, acquisitions and consolidations. On Thursday, January 23, Rivkin Radler’s first Health Law Executive Briefing, 2025 Healthcare Mergers & Acquisitions, will take the form of a Q&A session led by Benjamin Malerba and featuring Norton Travis, veteran healthcare…
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Owners of Transportation Company Defrauded Medicaid of $3.8M
January 03, 2025 | Douglas Menikheim | Fraud and Abuse | Litigation | Medicare and Medicaid

The New York State Attorney General’s Office announced on December 5 that Muhammad Rizwan Khan, Muhammad Usman Khan and Farhan Khan and their Orange County-based transportation companies, Tristate Express NY, Inc., Meditrans NY Inc. and Empire Trans NY Inc., pleaded guilty to various felony grand larceny charges in connection with…
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CTA Enforcement Halted Again
December 27, 2024 | Atara Kahn | Legislation and Public Policy

In a new twist to the ongoing legal battle over the Corporate Transparency Act (CTA), the Fifth Circuit Court of Appeals has reinstated a nationwide injunction blocking its enforcement. The December 26 decision reverses a ruling issued just three days earlier that had briefly allowed the law to proceed, leaving…
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Fifth Circuit Resurrects CTA; New Filing Deadline 1/13/25 [SUPERSEDED – SEE THE 12/27 POST]
December 24, 2024 | Atara Kahn | Legislation and Public Policy

On December 23, the Fifth Circuit Court of Appeals lifted the stay on the Corporate Transparency Act (CTA), reinstating its enforcement nationwide. The CTA requires certain non-exempt entities to report the identities of their beneficial owners to the U.S. Treasury Department in order to combat financial crimes such as money…
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LI Doctor Pleads Guilty to $900K Fraud Scheme
December 13, 2024 | Atara Kahn | Fraud and Abuse | Litigation | Medicare and Medicaid

Kenneth Fishberger, a Long Island internist with nearly 50 years of medical experience, recently pleaded guilty to conspiracy to commit healthcare fraud. Prosecutors revealed that from 2013 to 2019, Fishberger ordered hundreds of medically unnecessary transcranial doppler (TCD) brain scans in exchange for kickbacks. In this scheme, Fishberger collaborated with…
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CTA Update: U.S. Government Appeals Injunction & FinCEN Issues Guidance
December 10, 2024 | Stella Lellos and Lindsay Brocki | Legislation and Public Policy

Amid the ongoing legal battle over the Corporate Transparency Act (the CTA), updates continue to roll in. On December 5, the U.S. government filed a notice of appeal to the U.S. Court of Appeals for the Fifth Circuit (the “Fifth Circuit”) from the decision of the U.S. District Court for the…
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HHS-OIG Issues Nursing Facility Compliance Program Guidance
December 09, 2024 | Jeffrey Ehrhardt and Mary Aperance | Legislation and Public Policy | Medicare and Medicaid | Nursing Homes

On November 20, 2024, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) released the “Nursing Facility ICPG,” an industry-specific compliance program guidance for nursing facilities. Background The Nursing Facility ICPG serves as a voluntary, nonbinding tool to assist facilities in reducing risks related to…
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Upset in the 11th Hour: Corporate Transparency Act Halted, for Now
December 05, 2024 | Stella Lellos and Lindsay Brocki | Legislation and Public Policy

The Law The Corporate Transparency Act (the CTA), a law enacted by Congress requiring certain business entities to disclose beneficial ownership information (a BOI Report) to FinCEN, went into effect on January 1, 2024, and obligates reporting companies formed before January 1, 2024, to file BOI Reports on or before…
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Million Dollar Penalty Imposed on Pain Management Practice Following HIPAA Breach
December 05, 2024 | Ada Janocinska | Electronic Health Records | HIPAA

The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) announced on December 3 that it imposed a $1.19 million penalty on Gulf Coast Pain Consultants, a pain management practice in Florida, following a security breach that affected over 34,000 individuals. Gulf Coast filed a breach notification…
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Third-party biller fraud may hook your practice, unless you protect yourself
November 27, 2024 | Eric Fader | Fraud and Abuse | Litigation

A November 25 article in Part B News, “Third-party biller fraud may hook your practice, unless you protect yourself,” discussed the federal government’s recent fraud investigation of a medical biller in New York State and healthcare providers’ obligation to ensure the accuracy of their claims billing. Rivkin Radler’s Jeff Kaiser was…
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FinCEN Engages in Outreach as CTA Deadline Looms
November 21, 2024 | Stella Lellos and Lindsay Brocki | Legislation and Public Policy

By January 1, 2025, millions of existing businesses must have filed certain information with the Financial Crimes Enforcement Network (FinCEN) to remain in compliance with the Corporate Transparency Act (CTA). As this deadline approaches, concern is growing among lawmakers. During a House Financial Services Committee hearing, committee members highlighted that…
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Telehealth for 2025: Federal and State Legal Changes and Trends
November 20, 2024 | Rivkin Rounds Staff | Legislation and Public Policy | Telehealth

On Thursday, December 12, in the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, Rivkin Radler Partner Eric D. Fader will present an update on the regulatory landscape for the provision of telehealth services, including the latest trends and recent changes to federal and state laws and…
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On October 31, Elevance Health filed suit against the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) to challenge the 2025 Star Ratings system used for Medicare Advantage and Part D plans. CMS published the final Star Ratings to the public…
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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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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 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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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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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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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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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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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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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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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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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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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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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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RECENT HEALTH LAW NEWS

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