Rivas Goldstein, LLPNew York Health Care Law Attorney | Medical Licensing, Medicare Fraud2026-10-19T15:57:34Zhttps://www.rivasgoldsteinnyc.com/feed/atom/WordPressOn Behalf of Rivas Goldstein, LLP<![CDATA[The remote dilemma: A cautionary tale for physicians]]>https://www.rivasgoldsteinnyc.com/?p=502072026-10-06T15:59:52Z2026-10-19T15:57:34Z rise of remote medicine has created unprecedented opportunities for physicians to have increased flexibility. However, a recent criminal case from Rockland County, New York, serves as a stark warning of the legal and ethical pitfalls that await doctors who fail to manage these arrangements carefully.
The case that should concern every remote physician
In a recent example, New York City’s District Attorney announced the arraignment of a physician for multiple criminal charges including grand larceny. The prosecution argues that the physician double-billed – that she claimed to provide services for the New York State Office of Temporary and Disability Assistance in her capacity as a Medical Review Consultant while also working in person at a family services clinic. The allegations are a stark reminder of the importance of careful documentation, particularly when working remotely.
Protecting yourself while working remotely
For physicians legitimately balancing local practice with remote work or multiple remote work positions, this case offers important lessons. Remote physicians must take proactive steps to ensure their billing practices are beyond reproach and that they maintain clear boundaries between different employment obligations. Consider implementing the following protective measures:
Maintain clear time records that document exactly when you perform services for each employer or contract, including start times, end times and specific tasks completed
Implement calendar blocking systems that prevent scheduling conflicts and provide verifiable evidence that you were not performing services for multiple entities simultaneously
Retain all communications with employers, including emails, schedules and work assignments, as these documents can serve as evidence of your actual work patterns
Review your employment contracts carefully to understand any exclusivity clauses, time commitments or restrictions on concurrent employment that may apply to your positions
Submit billing documentation promptly with detailed descriptions of services rendered, as delays or vague descriptions may raise red flags during audits
Avoid any appearance of impropriety by ensuring your claimed work hours align with reasonable human capacity and do not suggest simultaneous service provision
It can also help to consult with a healthcare attorney before entering into multiple work arrangements to better ensure compliance with all applicable laws and contractual obligations.
The high stakes: Your medical license hangs in the balance
Allegations of double-billing and fraudulent billing practices do not just threaten criminal prosecution — they also pose a serious threat to your medical license and chosen profession. State medical boards view billing fraud as a serious breach of professional ethics that demonstrates a lack of integrity fundamental to medical practice. Even if criminal charges are reduced or dismissed, the medical board can independently investigate and impose sanctions ranging from probation and fines to suspension or permanent license revocation. The damage then ripples across state lines through the National Practitioner Data Bank, potentially destroying your ability to practice medicine anywhere in the country. The bottom line is clear: protecting your billing integrity is about more than avoiding legal trouble — it is about safeguarding the professional credential you have spent years earning and upon which your entire career depends.Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLP<![CDATA[Allegations of fraud at the pharmacy: A cautionary tale for pharmacy owners]]>https://www.rivasgoldsteinnyc.com/?p=502022026-10-05T16:17:27Z2026-10-15T16:16:35ZThe pharmaceutical industry operates under strict regulatory oversight, and pharmacy owners who violate these rules face severe consequences. A recent case from Jersey City, New Jersey serves as a reminder of the serious penalties that can result from fraudulent practices.
The Jersey City case: What went wrong
In this case, a pharmacy owner received a 30-month prison sentence after a conviction for submitting falsified documents to a healthcare benefits program. The prosecution gathered evidence to establish a pattern of deceptive practices that ultimately cost the owner his freedom and over $1.2 million in combined restitution and forfeiture payments.The allegations were extensive and damaging. Investigators found that the pharmacy owner had submitted documents falsely claiming that the prescriptions were authorized when no such authorization existed. Additionally, the owner created false documentation that customers had collected medications they never received.Perhaps most damning was evidence revealed during the investigation showing the pharmacy owner's own words describing his scheme. Investigators discovered messages to a friend where he bragged about billing his insurance thousands of dollars monthly for medications he never took, calling it free money. The investigation also uncovered allegations that he sent doctors to strip clubs and gave them cash payoffs to keep them "as corrupt as possible."
Protecting your pharmacy from fraud allegations
Aside from avoiding damning messages since anything written in text messages, emails or even social media can serve as evidence it is also important to consider the following steps to mitigate the risk of similar allegations:
Ensure all prescriptions have proper authorization from licensed medical providers before filling
Maintain accurate records of all prescription pick-ups with customer signatures
Implement regular internal audits of billing practices and documentation
Train staff on proper procedures for verifying prescription authenticity
These safeguards create a paper trail that protects both your patients and your business from fraudulent activity.
Move forward with purpose
The Jersey City case demonstrates that allegations of pharmacy fraud can carry devastating consequences including imprisonment, substantial financial penalties and permanent damage to professional standing. Pharmacy owners must prioritize compliance, maintain clear records and foster a culture of integrity. When in doubt about any business practice, consult with experienced legal counsel before proceeding.Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLP<![CDATA[Protecting your career: The high cost of exceeding scope of practice]]>https://www.rivasgoldsteinnyc.com/?p=501962026-09-22T17:58:32Z2026-09-30T17:57:02Z ability to practice medicine, nursing, dentistry or other state regulated profession comes with clearly defined boundaries. Whether you are a health professional, understanding and respecting the scope of your state licensure is not just a formality — it is essential to protecting your career, your patients and your livelihood.
The serious consequences of practicing outside the bounds of your licensure
Practicing outside the bounds of your state license can trigger a cascade of professional and legal problems. State licensing boards take scope-of-practice violations seriously, and the repercussions can be severe and long-lasting.When professionals stray beyond their authorized scope, they may face:
Disciplinary action from state licensing boards, including license suspension or revocation
Civil liability and malpractice claims from patients who experience harm
Criminal charges in cases involving unauthorized practice of medicine or other professions
Loss of hospital privileges and professional affiliations
Damage to professional reputation
These consequences extend far beyond temporary setbacks. A single scope-of-practice violation can permanently alter your professional trajectory and financial stability.
When allegations arise: understanding your defense options
Unfortunately, even conscientious professionals may face allegations of practicing outside their scope. Sometimes these claims stem from misunderstandings, competitive disputes or patient dissatisfaction rather than actual violations. If you find yourself facing such allegations, several defenses may apply, including:
Demonstrating that the activities in question fall within recognized standards of practice for your profession
Providing evidence of additional certifications or training that expanded your authorized scope
Showing that you acted under appropriate supervision or delegation from another licensed professional
Proving that the allegations are factually inaccurate or based on mischaracterization of your actions
The availability and strength of these defenses depend heavily on your specific situation, your state's regulations and the documentation you have maintained throughout your practice.
Protecting your professional future
Your state license represents years of education, training and dedication. Protecting it requires constant vigilance about scope-of-practice boundaries. Stay informed about your state's specific regulations, seek guidance when facing unfamiliar situations and document your decision-making processes carefully. When questions arise about whether a particular activity falls within your scope, consult with experienced legal counsel before proceeding. Your license is too valuable to risk on assumptions.Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLP<![CDATA[What happens when your laboratory is accused of a False Claims Act violation?]]>https://www.rivasgoldsteinnyc.com/?p=501942026-09-11T19:20:08Z2026-09-22T19:18:31Z national clinical diagnostics laboratory company recently agreed to pay almost $15 million to settle allegations of a False Claims Act (FCA) violation. The allegations were tied to billing practices for urine drug testing, with the government claiming the lab billed for tests that lacked medical necessity. The Assistant Attorney General argued that the lab focused on “maximizing billing opportunities” instead of focusing on patient needs. The Assistant Attorney General also stated that this case is another example of the efforts they will take to continue their crackdown on healthcare fraud.
This crackdown continues to use one of the government’s most valuable tools: The FCA. The case highlights how the government can use the FCA to recoup large sums and provides valuable lessons for lab owners throughout the country. It is important to understand how these cases unfold so owners and interested parties can mitigate the risk of becoming a subject of an FCA violation investigation and know how to respond if they find themselves in the government’s crosshairs.
How does it start?
When allegations surface, the government typically conducts a thorough investigation before taking formal action. This period can last months or even years. During this time, investigators will generally review billing records, medical documentation and compliance procedures. Laboratory owners may not even be aware an investigation is underway, as many cases begin with sealed qui tam lawsuits filed by whistleblowers.Once you receive formal notification, the stakes are clear. The FCA allows for significant financial penalties as well as exclusion from Medicare and Medicaid programs and reputational damage that can devastate your business relationships.These consequences underscore the importance of taking allegations seriously from the outset. Even unintentional billing errors can result in substantial liability under the FCA's strict standards.
What are my response options?
Laboratory owners facing FCA allegations have several potential paths forward. The response you choose can significantly impact the outcome of your case. Options often include:
Cooperating fully with the investigation and potentially negotiating a settlement
Conducting an internal audit to identify and correct any compliance issues
Engaging legal counsel with experience in healthcare fraud defense
Implementing enhanced compliance programs to demonstrate good faith efforts
Each situation is unique, and the appropriate strategy depends on the specific allegations and evidence involved. However, one universal truth applies: it is unwise to ignore the allegations.
How can I protect my laboratory?
Whether you are currently facing allegations or hoping to prevent them, robust compliance programs are one of your best defenses. Regular audits, staff training and clear documentation protocols can help identify potential issues before they become legal problems. The cost of prevention is always lower than the cost of defense.False Claims Act allegations represent serious legal challenges that require immediate attention and experienced guidance. By understanding the process and responding appropriately, laboratory owners can navigate these difficult situations while protecting their business interests and professional standing.Attorney John Rivas is responsible for this communication.]]>On 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.]]>