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...more
In November 2024, the U.S. Department of Health and Human Services’ Office of the Inspector General (“OIG”) published the long-awaited Industry Segment-Specific Compliance Program Guidance for Nursing Facilities (“Nursing...more
3/26/2025
/ Compliance ,
Compliance Monitoring ,
Department of Health and Human Services (HHS) ,
Healthcare Facilities ,
Long Term Care Facilities ,
New Guidance ,
Nursing Homes ,
OIG ,
Quality of Care Standards ,
Regulatory Oversight ,
Regulatory Requirements ,
Risk Management
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...more
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...more
2/14/2025
/ Artificial Intelligence ,
Audits ,
Compliance ,
Data Privacy ,
Fraud ,
Health Care Providers ,
Healthcare ,
Healthcare Fraud ,
Medicaid ,
Nursing Homes ,
OIG ,
Public Health ,
Regulatory Agenda ,
Reporting Requirements
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....more
12/9/2024
/ Anti-Discrimination Policies ,
Anti-Kickback Statute ,
Billing ,
Breach Notification Rule ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Department of Health and Human Services (HHS) ,
Fraud Abuse and Waste ,
Health Insurance Portability and Accountability Act (HIPAA) ,
OIG ,
Public Policy ,
Quality of Care Standards ,
Skilled Nursing Facility
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...more
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)...more
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...more
As previously discussed , 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...more
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...more
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...more
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...more
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...more
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...more
On Thursday, April 11, the next installment of Rivkin Radler’s Healthcare Compliance Lunch & Learn series, will be presented by Rivkin Radler attorneys, Bob Hussar, Chris Kutner and Mary Aperance. The program, “Defending...more
On February 6, the U.S. Department of Health and Human Services (HHS) announced a $4.75 million settlement with Montefiore Medical Center (MMC) for a breach of unsecured electronic protected health information (ePHI). The...more
On December 19, Michael Lonski, a Greenwich psychologist, was sentenced to a 27-month prison term and three more years of supervised release for a scheme to defraud Medicaid. Lonski submitted over 80,000 claims from 2014 to...more
On May 2, the U.S. Attorney’s Office for the Eastern District of Pennsylvania announced that the United States has filed a complaint under the False Claims Act (FCA) against James McGuckin, an interventional radiologist. The...more
On April 25, the New York State Department of Health (DOH) issued a Dear Adult Care Facility Administrator Letter (DACF #23-15) after it came to the DOH’s attention that some ACF operators have interpreted recent regulatory...more
Please join us for the May Lunch and Learn as Robert Hussar and Mary Aperance present on the fifth and sixth required elements of an Effective Compliance Program. They will discuss:
- Disciplinary Standards
- Auditing...more
The New York State Department of Health (DOH) issued Dear Adult Care Facility Administrator Letter (DACF) #23-02 on March 29 announcing that adult homes, enriched housing programs, and assisted living residences will have a...more
The New York State Department of Health (DOH) adopted regulations effective February 22, 2023, which clarify certain resident admission and retention standards applicable to adult care facilities (ACFs), including adult...more
An audit by the New Jersey Office of the State Comptroller (OSC) found that John Gore, a licensed drug and alcohol counselor, improperly billed and received over $1 million in Medicaid payments for services provided between...more
Please join us on February 9 as Partner Bob Hussar and Associates Ashley Algazi and Mary Connolly present on OMIG’s finalized regulations.
On December 28th, the Office of Medicaid Inspector General (OMIG) released their...more
On November 9, the Pharmaceutical Coalition for Patient Access (PCPA) filed an action against the U.S. Department of Health and Human Services (HHS) after HHS’s Office of Inspector General (OIG) determined that a proposed...more