The federal government recently charged a New York businessman with health care fraud. The entrepreneur ran a non-emergency medical transportation business in the Buffalo area. The business provided services from 2016 through 2020. It was composed of about 15 vehicles...
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Health & Health Care Law
3 ways feds are cracking down on pandemic related healthcare fraud
The feds are aggressively pursuing allegations of healthcare fraud related to relaxed regulations and incentives to help address the pandemic. In a recent example, the government charged 14 people with healthcare fraud related to the pandemic. They claim that those...
Feds ask for $200M in overpayments from Medicare Advantage group
In what the Health and Human Services Office of Inspector General is calling the largest audit penalty every imposed on a Medicare Advantage company, the feds have recently completed and an audit and are calling on the company to pay over $200 million back in Medicare...
Anatomy of an HHS audit
The United States Department of Health and Human Services (HHS) recently announced updates to its Phase 2 Health Insurance Portability and Accountability Act (HIPAA) Audit Program. These audits aim to check for an entity’s compliance with certain requirements. The...
Government takes steps to add oversite to pharmaceutical mergers
The Federal Trade Commission (FTC), U.S. Department of Justice Antitrust Division, and offices of state attorneys general along with the Canadian Competition Bureau, European Commission Directorate General for Competition, and U.K.’s Competition and Markets...
NY to insurance providers, cannot deny claims for administrative reasons
In a recent win for hospitals throughout the state, the New York Department of Financial services recently stated insurance providers cannot deny hospital claims based on “administrative reasons.” More specifically, the letter states that insurance provers cannot deny...
Medical board investigation can be beginning of bigger problems
An investigation by your state medical board is a big deal. It can lead to steep fines and even a revocation of your medical license, making it impossible to continue your practice in that state. Unfortunately, this could just be the beginning. In some cases, an...
New Jersey lawmakers push for hospice care reform
Lawmakers in New Jersey are working to reform the regulations surrounding hospice care in the state. Governor Phil Murphy has already singed one proposal into law and two additional proposals are currently under consideration. Lawmakers point to the fact that New...
Whistleblower wins millions in FCA case
The False Claims Act (FCA) allows others to initiate a claim on behalf of the government. If the claim moves forward, the government may choose to join. If it leads to a settlement or award, the individual who initiated the case gets a portion of the award. As a...
Three tips for pharmacy owners looking to sell in ‘21
Those who have built not just a profession as a pharmacist, the business of the pharmacy as well will likely treat retirement differently compared to pharmacists who have chosen to work for a hospital or retail chain. Those who own their own pharmacy must also look to...