The U.S. Department of Justice (DOJ) announced on March 3 that Ameet Goyal, M.D., a Westchester-based ophthalmologist, was sentenced to 96 months in prison for falsely billing for millions of dollars of upcoded procedures...more
We don’t often cover brand-new proposed legislation on Rivkin Rounds, generally preferring to wait until it’s closer to becoming law. However, two bipartisan bills introduced in Congress last week are worthy of mention....more
2/15/2022
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Electronic Protected Health Information (ePHI) ,
Health Care Providers ,
Health Insurance Portability and Accountability Act (HIPAA) ,
Legislative Agendas ,
Medicare ,
PHI ,
Privacy Laws ,
Proposed Legislation ,
Telehealth
On January 24, New York Attorney General Letitia James announced a settlement with EyeMed Vision Care LLC based on shortcomings in the company’s data security procedures. The problems were discovered during the state’s...more
2/1/2022
/ Breach Notification Rule ,
Cybersecurity ,
Data Breach ,
Hackers ,
Health Information Technologies ,
Medicaid ,
Medicare ,
PHI ,
Policies and Procedures ,
Popular ,
State Attorneys General
A study recently released by the U.S. Department of Health and Human Services (HHS) found that the number of beneficiaries in the traditional Medicare program who used telehealth increased from 840,000 in 2019 to nearly 52.7...more
The 2022 Medicare Physician Fee Schedule Final Rule released on November 2 by the Centers for Medicare & Medicaid Services (CMS) added certain services to the Medicare telehealth services list through December 31, 2023. Last...more
Please join us as Rivkin Radler Partner Eric D. Fader provides an overview of changes in the provision of telehealth services and federal and state regulation of them, since the beginning of the COVID-19 pandemic. New rules...more
10/27/2021
/ Continuing Legal Education ,
Coronavirus/COVID-19 ,
Data Privacy ,
Data Security ,
Health Care Providers ,
Healthcare Fraud ,
Medical Billing Codes ,
Medicare ,
New Rules ,
Out of Network Provider ,
Physicians ,
Telehealth ,
Telemedicine ,
Webinars
On May 26, the U.S. Department of Justice (DOJ) announced criminal charges against 14 defendants in six states for participation in healthcare fraud schemes related to the COVID-19 pandemic. The coordinated takedown involved...more
5/27/2021
/ Coronavirus/COVID-19 ,
Department of Justice (DOJ) ,
False Billing ,
Fraud ,
Healthcare Fraud ,
Kickbacks ,
Laboratories ,
Medicare ,
Misappropriation ,
Pharmaceutical Industry ,
Provider Relief Fund ,
Telehealth
In an April 15 notice on its COVID-19 portal, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) reminded healthcare providers that COVID-19 vaccines must be administered at no out-of-pocket...more
The 2021 Physician Fee Schedule (PFS) final rule recently released by the Centers for Medicare & Medicaid Services (CMS) includes the addition of 60 new telehealth services that will be covered and reimbursed by Medicare. The...more
12/11/2020
/ Centers for Medicare & Medicaid Services (CMS) ,
Coronavirus/COVID-19 ,
Final Rules ,
Health Care Providers ,
Health Technology ,
Medicare ,
Physician Fee Schedule ,
Physicians ,
Reimbursements ,
Telehealth ,
Telemedicine
The U.S. Department of Justice announced on November 20 that Doctor’s Choice Home Care, Inc. agreed to pay $3,856,000 to resolve allegations that the agency paid illegal kickbacks to physicians for referring patients. The...more
The U.S. Department of Justice (DOJ) announced on October 29 that Medtronic USA Inc. agreed to pay $8.1 million to settle allegations that it violated the False Claims Act (FCA) and federal Anti-Kickback Statute by paying...more
11/13/2020
/ Affordable Care Act ,
Anti-Kickback Statute ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Department of Justice (DOJ) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Health Care Providers ,
Healthcare Fraud ,
Medical Devices ,
Medicare
On September 23, the U.S. Department of Justice announced that pharmaceutical company Gilead Sciences, Inc. agreed to pay $97 million to resolve claims that it illegally used a foundation as a conduit to pay the copays of...more
Teva Pharmaceuticals USA Inc. is in the crosshairs of the U.S. Department of Justice (DOJ) on two separate matters. On August 18, the DOJ announced that it filed a lawsuit against Teva and an affiliate, Teva Neuroscience...more
8/27/2020
/ Co-payments ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
FBI ,
Healthcare Fraud ,
Kickbacks ,
Medicare ,
Pharmaceutical Industry ,
Prescription Drugs ,
Price-Fixing ,
Private Foundations ,
Settlement
The U.S. Department of Health and Human Services (HHS) and Department of Justice (DOJ) have released the 2019 annual report for their Health Care Fraud and Abuse Control Program. The government recovered almost $3.6 billion,...more
7/23/2020
/ Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Electronic Medical Records ,
False Claims Act (FCA) ,
FBI ,
Fraud ,
Genetic Testing ,
Healthcare Fraud ,
Home Health Care ,
Medicaid ,
Medical Devices ,
Medicare ,
Prescription Drugs ,
Telehealth
The Visiting Nurse Service of New York (VNSNY) has agreed to pay $57 million to settle a whistleblower lawsuit that alleged it billed the Medicare and Medicaid programs for hundreds of millions of dollars in home care visits...more
6/29/2020
/ False Billing ,
False Claims Act (FCA) ,
Home Health Agencies ,
Hospice ,
Medicaid ,
Medicare ,
New York ,
Nonprofits ,
Nurses ,
Patient Referrals ,
State and Local Government ,
Whistleblower Awards ,
Whistleblowers
On June 16, the U.S. Court of Appeals for the District of Columbia Circuit upheld a ruling from a year ago that struck down a federal regulation requiring pharmaceutical companies to disclose wholesale prices of prescription...more
On April 30, the Centers for Medicare & Medicaid Services (CMS) announced numerous regulatory waivers and rule changes to, among other things, expand Medicare beneficiaries’ access to coronavirus testing and telehealth...more
On April 6, Rivkin Radler’s Eric Fader presented a COVID-19 Business Briefing on Telehealth. The Briefing covered recent developments in federal and state law and policy, and changes in private insurers’ policies, that have...more
The Centers for Medicare & Medicaid Services (CMS) has released an updated edition of its Medicare Learning Network Telehealth Services booklet....more
The “Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020,” signed into law by the President on March 6, includes provisions waiving Medicare’s geographic restrictions on telehealth during a public...more