Rivas Goldstein, LLPNew York Health Care Law Attorney | Medical Licensing, Medicare Fraud2026-09-05T00:27:44Zhttps://www.rivasgoldsteinnyc.com/feed/atom/WordPressOn Behalf of Rivas Goldstein, LLP<![CDATA[Why Medicare overpayment allegations can lead to multimillion-dollar repayments]]>https://www.rivasgoldsteinnyc.com/?p=501842026-09-05T00:27:44Z2026-09-04T16:34:38Z a company participates in federal health care programs like Medicare it agrees to follow detailed billing, coding and documentation rules. A finding of overpayment and request for repayment can devastate any health care organization. In a recent example, the government claimed a business received millions in overpayment and demanded repayment of funds. The Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) threatened to move forward with immediate sanctions including the suspension of communications and beneficiary enrollment if the business did not rectify the issue.
What happens when the government demands repayment?
As highlighted in the case noted above, in addition to repayment of large sums the CMS can also move forward with serious penalties such as suspension of privileges. Repayment demands like these typically move forward when investigators believe the government paid claims that were not payable under Medicare rules or were paid at an inflated rate. Common triggers include audits, data analytics that flag outlier billing patterns, whistleblower reports and referrals from Medicare contractors.
Why are the demands so large?
Even when the underlying overpayment per claim is modest, volume matters. The government often extrapolates from a sample of claims to a larger universe, and it may seek additional amounts for penalties or damages if it alleges false claims. Settlements also reflect litigation risk, reputational concerns and the cost of prolonged investigations.Multimillion-dollar repayments usually stem from a combination of alleged noncompliance and high claim volume, sometimes amplified by sampling, penalties and whistleblower pressure. These claims will likely gain momentum as the CMS celebrates its most recent win. If your business faces similar allegations, a prompt, structured response focused on facts, documentation and corrective action is often the best way to protect the organization while meeting Medicare obligations.Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLP<![CDATA[Protecting your cardiology practice: Understanding Anti-Kickback Statute risks in New York]]>https://www.rivasgoldsteinnyc.com/?p=501922026-08-20T19:01:13Z2026-08-27T19:00:08Z a cardiologist in New York, your reputation and medical license represent years of dedicated training and service. However, even well-intentioned business practices can expose you to serious allegations under the federal Anti-Kickback Statute (AKS). It is important to understand how routine referral arrangements might cross legal boundaries to protect your career.
What is the Anti-Kickback Statute?
The Anti-Kickback Statute is a federal criminal law that prohibits exchanging anything of value in exchange for patient referrals for services reimbursable by federal healthcare programs like Medicare and Medicaid. Violations can result in criminal penalties, civil fines up to $100,000 per violation, exclusion from federal healthcare programs and damage to your professional reputation.
What are some common referral practices that can raise red flags?
Many cardiologists unknowingly create AKS exposure through practices they consider standard business development. The following arrangements can attract regulatory scrutiny:
Offering primary care physicians financial incentives, gifts or entertainment in exchange for patient referrals
Providing free or below-market rent to physicians who refer patients to your practice
Paying referring physicians consulting fees that exceed fair market value for actual services rendered
Offering complimentary diagnostic testing or procedures to physicians who send referrals
Creating compensation arrangements where payments correlate directly with referral volume
These practices may seem like normal business relationship-building, but federal prosecutors and the Office of Inspector General view them as potential violations when they involve federally-funded patients.
How can I safeguard my practice in New York?
New York cardiologists are wise to implement compliance measures that demonstrate legitimate business purposes for all professional relationships. It can help to make sure all compensation arrangements are documented in writing, reflect fair market value and are not tied to referral volume or value and to establish compliance training programs for staff regarding appropriate referral practices. It is also helpful to conduct regular audits of referral patterns and financial relationships with referring physicians. Healthcare attorneys with experience in this niche area of law can provide further support, reviewing proposals before entering arrangements and mitigating the risk of any potential violations.The Anti-Kickback Statute presents real risks for cardiologists who engage in common referral-building activities. What appears to be standard networking or professional courtesy may constitute a federal offense when federal healthcare dollars are involved. Protecting your license requires understanding these legal boundaries and implementing robust compliance measures. When in doubt about any arrangement involving referral sources, seek experienced legal counsel before proceeding. Your career is too valuable to risk on assumptions about what constitutes acceptable practice.Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLP<![CDATA[Why New York Medicare overpayments happen: The two most common triggers]]>https://www.rivasgoldsteinnyc.com/?p=501912026-08-11T16:39:26Z2026-08-19T16:38:26Z York healthcare providers face increasing scrutiny over Medicare billing practices. Understanding why overpayment allegations arise is the first step toward protecting your practice or facility from costly audits and potential legal consequences. While overpayment issues can stem from various sources, two of the most common triggers behind Medicare's recoupment efforts include the following.
#1: Insufficient payment documentation
The most common reason Medicare identifies overpayments is inadequate documentation to support the services billed. Even when the medical team provides appropriate care, poor record-keeping can result in repayment demands that threaten your practice's financial stability.Documentation failures that can trigger overpayment allegations include:
Missing or incomplete patient charts that fail to reflect the level of service billed
Absence of physician signatures or authentication on critical medical records
Lack of supporting test results or diagnostic information referenced in billing codes
Inadequate progress notes that do not justify the frequency of visits or treatments
Time-based billing without proper documentation of actual time spent with patients
The burden of proof rests squarely on providers. When Medicare auditors cannot verify that services were rendered as billed, they will presume overpayment occurred. This makes meticulous documentation not just good practice but essential protection against allegations.
#2: Failure to demonstrate medical necessity
The second major trigger involves services that lack sufficient justification for medical necessity. Medicare only covers services that are reasonable and necessary for diagnosis or treatment. When documentation fails to establish why a particular service was medically appropriate, overpayment claims follow.Medical necessity issues frequently arise in these situations:
Performing diagnostic tests without documented clinical indicators supporting their use
Providing treatment that appears excessive given the patient's documented condition
Billing for services that seem duplicative or inconsistent with accepted treatment protocols
Ordering durable medical equipment without adequate justification in the medical record
Providers must demonstrate through clear clinical documentation that each service addresses a specific medical need. Vague or boilerplate notes will not satisfy Medicare's standards during an audit.
Protecting your practice
Both documentation deficiencies and medical necessity failures share a common solution: comprehensive, contemporaneous record-keeping that clearly connects each service to clinical justification. New York providers should implement robust compliance programs that emphasize documentation training and regular internal audits. When overpayment allegations do arise, consultation with experienced healthcare counsel can help you navigate the complex appeals process and potentially reduce or eliminate repayment obligations. Prevention through proper documentation remains your strongest defense against these two common overpayment triggers.Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLP<![CDATA[Practicing medicine in New York: why the “worst state” label matters more than you think]]>https://www.rivasgoldsteinnyc.com/?p=501892026-08-10T18:03:48Z2026-08-18T17:43:27Z you are a physician practicing in New York, you already know the daily challenges: administrative burdens, insurance headaches and costs that seem to climb endlessly. But here is something you might not know: New York consistently ranks among the worst states in the nation for physicians to practice medicine. This is not just an abstract statistic. It is a reality that affects your income, your work-life balance and your ability to provide the best care to your patients.
Understanding the ranking methodology
WalletHub's comprehensive analysis evaluated all 50 states and the District of Columbia and examined two primary dimensions: opportunity and competition, and medical environment. Within these categories, researchers assessed 19 different metrics that directly impact physician careers.The metrics paint a complete picture of what it means to practice medicine in each state. They include factors such as average annual wage, quality of the public health system and hospital safety grades. Each metric received a score on a 100-point scale, where 100 represents the most favorable conditions. New York's persistently poor showing in these rankings reveals systemic issues that directly impact physicians.
What this means for your practice
The implications of New York's low ranking reflects real-world conditions that affect your daily professional life in several ways, including:
Higher malpractice insurance premiums eat into your earnings
Excessive regulatory requirements consume time better spent with patients while also adding stress of possible allegations of a violation
Elevated cost of living reduces your actual purchasing power despite seemingly competitive salaries
These challenges create a ripple effect throughout your career. When administrative costs rise and reimbursement rates fail to keep pace, you face difficult decisions about staffing, equipment and even whether to accept certain insurance plans.
The broader impact on healthcare delivery
Beyond personal financial considerations, New York's hostile practice environment affects the entire healthcare ecosystem. Physicians who feel overburdened and undercompensated experience higher rates of burnout. This leads to:
Reduced patient satisfaction as stressed physicians have less time for individualized care
Difficulty attracting new physicians to underserved areas of the state
Increased likelihood of experienced physicians relocating to more favorable states
The medical environment metrics in the WalletHub study highlight concerns about public health infrastructure and hospital safety that should alarm both physicians and patients alike.
Moving forward
While New York offers unparalleled cultural opportunities and a diverse patient population, the state's poor ranking for physicians demands attention from policymakers and healthcare administrators. Understanding these challenges is the first step toward advocating for meaningful change that benefits both physicians and the patients who depend on them.Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLP<![CDATA[New York gets high health care rating, can prove a strategic investment opportunity]]>https://www.rivasgoldsteinnyc.com/?p=501882026-07-28T17:07:33Z2026-08-06T17:06:45Z investors seeking promising opportunities in the health care sector, New York presents a compelling case. The state's consistent rankings in the top ten for both health care delivery and public health infrastructure reflect a mature, stable market with significant growth potential. These metrics are not merely statistics — they represent tangible indicators that signal favorable conditions for strategic investment.
Understanding New York's health care landscape
New York has earned its position among the nation's health care leaders through decades of infrastructure development, regulatory refinement and commitment to public health initiatives. The state's dual recognition — excelling in both health care services and public health outcomes — demonstrates a comprehensive ecosystem that supports sustainable investment returns.When a state ranks highly in health care delivery, it indicates several critical factors that investors should note:
Strong regulatory frameworks that provide clarity and stability for health care operations
Robust reimbursement systems that help to better ensure consistent revenue streams
Advanced medical infrastructure that attracts top talent and cutting-edge research
High patient volumes that support facility utilization rates
These elements create an environment where health care investments can thrive with reduced regulatory uncertainty and established operational precedents.
Public health rankings as investment indicators
New York's top-ten ranking in public health is equally significant for investors. Strong public health systems indicate proactive disease prevention, health education and community wellness programs that reduce long-term health care costs while improving population outcomes.The synergy between excellent health care delivery and strong public health creates a multiplier effect that benefits investors through market stability and growth opportunities.
Moving forward with confidence
New York's dual rankings reflect a state that has made health care and public health priorities, resulting in a mature market with proven performance. For investors, these metrics remove much of the guesswork associated with emerging markets. The infrastructure exists, the demand is established and the regulatory environment is sophisticated yet navigable.The convergence of strong health care delivery systems and robust public health frameworks positions New York as an ideal location for health care investment. These rankings are not temporary achievements but rather the result of sustained commitment and infrastructure development that will continue supporting investor success for years to come.Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLP<![CDATA[Health care businesses: Watch out for this major AI hurdle]]>https://www.rivasgoldsteinnyc.com/?p=501862026-08-04T21:03:53Z2026-07-30T19:29:52Z intelligence is transforming health care at an unprecedented pace. From diagnostic imaging that detects cancer earlier than human eyes can see to predictive analytics that identify at-risk patients before conditions become critical, AI promises to revolutionize how we deliver care. Administrative tasks that once consumed hours now take minutes. Drug discovery timelines are shrinking from years to months. Patient outcomes are improving while costs decline.
Yet beneath this wave of innovation lurks a significant challenge that health care organizations cannot afford to ignore: insufficient support.
The vendor implementation gap
Here is where many health care organizations hit an unexpected wall. After investing in promising AI solutions, they are often left to discover that vendors expect them to shoulder the heaviest burden of implementation. The sophisticated algorithms and impressive demonstrations suddenly require extensive customization, data preparation and integration work that falls squarely on the health care organization's shoulders.The problem extends beyond initial setup. Vendors often provide the AI engine but leave health care businesses to handle ongoing model training, performance monitoring and continuous improvement. Organizations discover they need data scientists, AI specialists and technical resources they simply do not have. A failure to have the support they need can lead to more than delays, it can impact the organization’s ability to provide care and could trigger billing mistakes.
Moving forward strategically
Before committing to AI solutions, health care businesses must ask vendors pointed questions about implementation support. Who handles data integration? What training and change management resources are included? How much ongoing technical support comes standard versus at additional cost?The organizations seeing the greatest AI success are those that recognize this hurdle early and plan accordingly. They negotiate comprehensive implementation support, build internal AI literacy and start with narrowly defined projects that deliver quick wins. AI will undoubtedly transform health care, but only for organizations that clear the implementation hurdle standing between promise and reality.Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLP<![CDATA[Avoid these four red flags when investing in a home health agency or hospice center ]]>https://www.rivasgoldsteinnyc.com/?p=501822026-08-04T18:04:53Z2026-07-22T19:35:42Z in a home health agency or hospice center can be rewarding, but it is also highly regulated and operationally complex. The key between a wise investment and a costly headache is often disciplined diligence. While working through a thorough due diligence process, four red flags that can cause problems to watch out for include the following.
Red flag 1: Unverifiable referral sources and marketing practices
Before reviewing financials, confirm how the group acquires patients and whether those practices comply with federal and state fraud and abuse laws. A target that cannot clearly explain its referral channels, contracts and compensation structures may be carrying significant exposure. Warning signs can include:
Heavy reliance on a small number of referral sources with limited documentation
Marketing agreements that pay per referral, per patient or appear tied to volume or value
Missing or inconsistent physician orders, certifications or hospice eligibility support
If any of these appear, require a deeper compliance review, contract remediation and potentially a purchase price adjustment or escrow.
Red flag 2: Billing patterns that do not match clinical reality
Revenue quality matters more than revenue quantity. In home health and hospice, billing errors can trigger audits, repayment demands and even exclusion risk. Compare clinical documentation to claims data and look for patterns that suggest upcoding or insufficient support.
Red flag 3: Weak licensure or change of ownership readiness
Licenses and certifications are not administrative details. They are the foundation of continued operations and reimbursement. Review state licensure status and Medicare certification. Also confirm whether the business can survive a change of ownership without service disruption, including payer enrollment timing and any state-specific approval requirements.
Red flag 4: Employment and contractor misclassification risks
Labor issues can quietly erode value through wage claims, tax exposure and continuity problems. Evaluate for proper clinician classification, credentialing and supervision as well as whether productivity expectations align with documentation requirements.A home health agency or hospice center can be a strong investment when compliance, documentation and operations are aligned. Treat these four red flags as a structured screening tool. When you identify risk early, you can either fix it with clear deal terms or walk away before the liability becomes yours.Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLP<![CDATA[Feds announce crackdown on Medicare overpayments: Two things to know]]>https://www.rivasgoldsteinnyc.com/?p=501792026-07-07T21:18:47Z2026-07-07T19:20:58Z Government Accountability Office (GAO) recently announced the federal government overpaid Medicare claims by almost $57 billion in 2025. This marks a significant uptick from reports of fraudulent payments in previous years which were closer to $12 billion.
The announcement comes shortly after Vice President JD Vance took the lead in a fraud task force that focused on pressuring states like New York to root out fraud or lose federal funding. Health care organizations and private practices should be aware of the following takeaways from the announcement.
#1: The government is continuing its crackdown on Medicare overpayments
The GAO has made it clear that it sees Medicare as a “high-risk” program. As such, there is unlikely to be an easing of the continued crackdown on review of Medicare claims in coming years. Groups are wise to conduct internal audits to make sure their practices are in compliance with applicable regulations and make changes as needed to reduce the risk of allegations of fraudulent claims.
#2: Health care organizations and private practices need to have a response plan
Receiving a Medicare overpayment notice is unsettling for any health care business in New York. Still, the notice is not the end of the story. It is a prompt to act quickly, preserve documentation and choose the right response path. Allegations of overpayments can arise from coding issues, medical necessity determinations, duplicate billing, coordination of benefits problems or post-payment audits by a Medicare Administrative Contractor or other review entity. It is helpful to treat the notice as both a financial and compliance event.Although the exact response depends on the organization and notice, general practices that are helpful include:
Review notice for important deadlines
Organize applicable records and correspondence
Notify leadership and compliance personnel and consider engaging experienced counsel early
After applying the response plan, you typically have several routes: repay, request a redetermination or other appeal level, seek a rebuttal to recoupment where available or pursue an extended repayment schedule if cash flow is a concern. The best option depends on the strength of the documentation, the legal theory behind the denial and the business impact of recoupment.The announcement is a reminder of the government's continued focus on fraudulent claims and likely signals an increase in investigative efforts. As such, groups and health care organizations are wise to prepare for potential investigations and review strategies to address a notification of a Medicare overpayment. Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLP<![CDATA[When executive perks become a federal funding problem]]>https://www.rivasgoldsteinnyc.com/?p=501762026-06-16T18:12:43Z2026-06-10T13:00:04Z that receive federal dollars operate under a heightened level of scrutiny. While compensation, travel and executive transitions are normal parts of running a health system, using federal funds to cover meals, travel or separation payouts improperly can quickly move from an internal compliance issue to a federal concern. A recent investigation highlights how weak controls, inaccurate reporting or a disregard for reimbursement rules can trigger an official investigation.
Though New York state’s attorney general’s office has not provided much information about the reasons behind the investigation, the investigation of a hospital in Nassau County likely focuses on the allegedly improper provision termination payments and improper use of public money towards meals and travel.
Why meals, travel and exit payouts can draw attention
Federal funds frequently come with strings attached, including allowability standards, documentation requirements and restrictions on entertainment, travel class, per diem and “reasonableness” of costs. If a hospital uses federal funds to help cover executive expenses without a solid basis, it can face inquiries from auditors, oversight agencies or law enforcement.
How a routine audit can turn into an investigation
Many federal investigations begin with something ordinary: a hotline complaint, a whistleblower allegation, an adverse audit finding or a repayment dispute. Once questions arise about the use of federal funds, investigators may request policies, board minutes, employment agreements, expense reports and general ledger detail. They may also interview employees who processed payments or approved reimbursements.
Practical steps to reduce exposure
Hospitals can regularly conduct internal audits to help reduce risk. It is also beneficial to have clear rules around executive travel and meals to better ensure compliance. For exit packages, confirm that payouts follow written agreements, are supported by contemporaneous approvals and are evaluated for allowability before funding sources are assigned.Federal dollars are not interchangeable with unrestricted operating funds. Improper charges for executive meals, travel or departure payments can trigger audit scrutiny and potentially lead to a broader federal investigation. Strong governance, disciplined documentation and careful cost allocation can help safeguard the organization from allegations of wrongdoing.Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLP<![CDATA[Staying within the bounds of nursing licensure]]>https://www.rivasgoldsteinnyc.com/?p=501742026-06-03T22:48:20Z2026-05-28T15:37:40ZThose who have worked to earn their nursing licensure have put in countless hours studying and gaining clinical experience. Once in their chosen field, nurses also gain additional knowledge and skill on the job. In many cases, they may feel comfortable providing services that could be outside the scope of practice. It is important for nurses to understand what they can and cannot do and to tread carefully. A single misstep can trigger an allegation that could threaten everything.
Why scope boundaries matter to the board
State nursing boards investigate conduct for various reasons. Common examples include allegations of unsafe practice, unprofessional behavior or impairment. “Beyond scope” concerns often arise after a patient complaint, employer report, adverse event, chart audit or unusual prescribing pattern. Even well intentioned actions can be viewed as unauthorized practice when they bypass required credentials, protocols, orders or supervision.
Examples that can trigger a nursing board investigation
Common complaints include:
Performing a medical act without authority, such as independently diagnosing, prescribing or altering medication orders without a licensed prescriber order
Administering high risk medications or sedation outside required training, competency or supervision standards
Delegating tasks improperly, such as assigning assessment or medication administration to unlicensed staff
Inadequate assessment or triage, such as failing to escalate a change in condition or delaying provider notification
Documentation issues, such as charting after the fact without proper notation, copying forward inaccurate information, or incomplete medication reconciliation
These situations often involve a true intent to help or balance difficult staffing strain. Regardless, boards will still focus on patient safety and adherence to legal standards.
What to do if you are under investigation
An investigation is serious but you can mitigate the fallout with a structured approach. Early decisions can shape outcomes, especially statements, record handling and employment communications.
Review the notice carefully, note deadlines, request the allegation summary if unclear
Avoid informal explanations to investigators or managers until preparation is complete
Preserve records, keep a timeline, identify witnesses, gather policies, competency files, training logs
Seek experienced licensing counsel, consider malpractice carrier resources when available
Continue safe practice, request supervision or reassignment when a scope question exists
These steps support accuracy, reduce misunderstandings and can help to demonstrate professionalism and insight.Practicing within licensure scope protects patients, supports professional credibility and safeguards the license that supports a nursing career. Those who find themselves under investigation can review the steps outlined above to get an idea of potential actions to protect their future in their chosen profession. An attorney with experience in this niche area of law can provide further guidance and advocate for your interests. Attorney John Rivas is responsible for this communication.]]>