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New York Health Care Law Blog

Physicians groups and DOJ settle kickback claims

Negative publicity began to swirl around now-shuttered Health Management Associates back in 2012 when news magazine “60 Minutes” aired a segment alleging that the hospital chain pressured emergency room doctors to admit patients whether they needed care or not. The pressure on HMA escalated two years later when the New York Times reported that the company inflated its Medicare and Medicaid payments by pressuring physicians to admit at least half of patients age 65 and above.

Now two physician groups have agreed to pay more than $33 million to settle health care fraud allegations that they received illegal kickbacks for patient referrals to HMA facilities.

Eye doctor awaits sentencing for Medicare fraud conviction

Two very different portraits were painted recently of Dr. Salomon Melgen, the Harvard-trained ophthalmologist. At his sentencing hearing, Melgen was painted by prosecutors as a greedy doctor willing to subject his patients to painful treatments that were medically unnecessary so that he could bill Medicare. Melgen's defense team said that portrait was a false one and insisted that the doctor is devoted to his patients and had helped many to regain sight after other physicians had given up on them.

Melgen is awaiting sentencing on his April conviction on 67 counts of Medicare fraud. In a statement to the court, the eye doctor conceded that he has made mistakes in his personal life, but that he was always committed to helping his patients. As he read his statement to the court dressed in prison garb and bound by shackles, the 63-year-old asked for mercy.

New York nurse has license suspended for drug violation

We have made the point more than once in this space: New York State has tough requirements for those who want to be licensed as a nurse here.

One of the requirements is vague and can be understood in more than one way: you must "be of good moral character." A licensed practical nurse who apparently sold crack cocaine recently had her nursing license suspended for professional misconduct, a news outlet reported.

Court rejects Medicare fraud appeals

"Upon thorough review and with the benefit of oral argument, we affirm on all issues," the U.S. Court of Appeals for the Eleventh Circuit said as it shot down the hopes of a doctor and three therapists. The four had appealed their convictions on conspiracy to commit health care fraud.

The court rejected their claim that their Florida trial had been unfair, as it upheld prison sentences and restitution ordered for "an extensive Medicare fraud scheme" that lasted seven years.

Kool Smiles and management company settle False Claims case

The U.S. Department of Justice announced recently that it has achieved a settlement with Kool Smiles dental clinics and their management company, Benevis. The clinics and management company are accused of charging Medicaid programs in 17 states for unnecessary pediatric dental services and for services that were never performed. This allegedly violated the False Claims Act.

The government alleges that these unnecessary and unperformed procedures were the result of a system of production incentives. "Unproductive" dentists were disciplined and "productive" ones were given substantial cash awards based on how much revenue they generated. These incentives made encouraged the dentists to look beyond sound dental practices and increase their billings regardless of the value to patients.

Four face prison for health care fraud, Anti-Kickback violations

It is about a 10-hour drive from the densely packed, bustling streets of New York City to the wide open, quiet cornfields and farms of Indiana. The pace of life and the cultures of the two places are worlds apart, but we are also linked by factors common to us both.

For instance, it makes little difference whether a person is charged with a federal crime in New York or Indiana. Federal allegations of health care fraud are for all intents and purposes the same here and there. In both places, convictions on the charges can mean years behind bars in a federal prison.

Are you a nurse facing disciplinary action in New York?

The nursing profession has many risks for practitioners, and in order to keep your license, you must follow the New York State nursing license requirements. If the licensing board believes you have violated the regulations, it may compel you to appear for a disciplinary hearing.

This can be a stressful time for you, and the hearing can determine your career future. There are many steps you can take to ensure you work toward the best possible outcome in terms of your disciplinary hearing. Here are a few things to keep in mind.

Health care's bounty system

In the Old West, bounty hunters wore cowboy hats and spurs. They would pursue fugitives across plains, through valleys and over mountains in search of a payday. Today, bounty hunters wear business attire and might work for the federal government, suppliers of durable medical equipment, home health care companies or other providers.

They are in pursuit of investigation targets that could mean big paydays from whistleblower lawsuits filed under the False Claims Act. Those whistleblower claims benefit both the federal government and the person who files the lawsuit. (Whistleblowers can receive up to 30 percent of settlements and awards.)

3 tips for reacting to the threat of losing your nursing license

When you receive a notice from the Office of Professional Discipline at the New York State Education Department about your nursing license, you may feel confusion, anger and stress. You likely feel furious that a patient or someone else reported you to the nursing board instead of resolving issues with you first.

However, you should be careful not to act on your emotions. How you respond to a threat of losing your nursing license can significantly impact the outcome. Here are some tips for how you should react when you face discipline or investigation as a nurse. 

Health care fraud alleged against 4 New York City doctors, others

New York's WNBC recently reported on an alleged health care scam that has cost taxpayers more than $100 million. “This massive scheme, which provided no patient care at all, wasted millions of taxpayer dollars dedicated to Medicaid and Medicare," said Brooklyn's acting District Attorney Eric Gonzalez.

Law enforcement authorities claim that an NYPD surgeon, three other doctors and 17 additional people engaged in Medicare and Medicaid fraud. Along with those 20 individuals, 14 corporations were also named in the 878-count indictment.