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New York Health Care Law Blog

OIG accuses sleep study providers of false billing practices

The Office of the Inspector General (OIG) recently released a report that the government overpaid for over half of reviewed payment requests to Medicare for polysomnography services. Overall, the agency estimates the government overpaid by $269 million for these sleep study services.

Look-back period extended for some Medicare overpayments

The Office of the Inspector General (OIG) recently conducted an audit of Medicare claims for a specific medical device. The agency found the majority of Medicare claims for this device, the positive airway pressure device and associated supplies, did not comply with Medicare requirements. As a result, the agency called on those who filed claims with Medicare for payment for these devices to “exercise reasonable due diligence to investigate and return any identified overpayments, in accordance with the 60-day rule.”

NY medical practice admin pleads guilty to health care fraud

A pain management facility in New York was the subject of a recent federal investigation. The investigation led to two separate indictments. The first involved two chiropractors, a business manager and an administrator. The government charged all four individuals with health care fraud and conspiracy to commit health care fraud. The second indictment included a pain management medical doctor formerly affiliated with the facility.

New finding in opioid crackdown: Doctors are just the beginning

A recent investigation delves more deeply into the details of the opioid crisis. It digs into a new area of concern: the courtroom. The investigation focuses on the role of judges in these cases and how they may have missed an opportunity to address this growing issue over 15 years ago.

NY cardiologist charged with healthcare fraud for ECP treatments

Assistant United States Attorneys recently accused a 53-year-old cardiologist of perpetrating a scheme in states throughout the country to defraud the health care benefit programs in exchange for personal profit.

Though indicted in Pennsylvania, the physician also provided services in Florida and New York.

Link between the college admission scandal and healthcare fraud

The college admission scandal was top of the news headlines just a few weeks ago. The scandal involved members of the Hollywood elite along with other wealthy parents paying bribes to get their children spots in prestigious universities. The fallout of the problem remains to be seen as parents fight allegations in court, colleges sort through admissions to determine the best course of action for their universities and students who were often unknowingly the subject of the scandal attempt to get on with their lives.

Can the home health care industry handle growing need for PCAs?

Every day in the United States, approximately 10,000 people turn 65. Within this group, the majority hope to receive long-term care within their own home. Instead of going to a nursing home or other long-term care facility, these individuals may look to hire medical professionals to help them remain within their homes.

One option: use of home health care agencies.

What does the contentious contract agreement mean for NY nurses?

The New York State Nurses Association recently settled a contract dispute with the New York City Hospital Alliance. Three of the largest local private hospital systems are part of the Alliance: Montefiore, Mount Sinai and New York Presbyterian.

What was the issue?

Nurses serving patients throughout New York have voiced concerns over dangerous nurse-to-patient staffing ratios and inadequate compensation. The settlement resulted in a four-year agreement which includes annual pay increases of 3% and increased tuition reimbursement as well as better retiree health benefits but failed to properly address better nurse-to-patient ratios.

Will recent medical lab breaches lead to more audits?

A data breach impacted an estimated 20 million patients from three medical testing labs. The breach was connected to the collection agency used by the lab to manage billing. At this time, it appears the breach occurred for eight months before the lab became aware of the issue.

Thus far, at least one case involved medical data.

Manhattan pharmacist accused of $11 million in insurance fraud

An investigation that spanned many months recently resulted in the arrest of a New York-licensed pharmacist accused of running a “medicine-for-case” scam. The Office of the Insurance Fraud Prosecutor recently announced the charges against this and 18 additional individuals allegedly involved in the scam, which allegedly ran from January through August of 2018.

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