Physicians must be aware that a full reporting of all adverse events, whether malpractice awards/settlements, license restrictions, hospital privilege issues, or insurance payor terminations, are set forth in a semi-public and centralized database known as the National Practitioner Data Bank (NPDB).» Read More

Considering the significant financial incentives and awards provided to whistleblowers, it should come as no surprise that there has been a marked increase in the number of health care fraud investigations commenced by federal and state agencies.  The New York State Medicaid Fraud Control Unit (“MFCU”) is one such agency and is increasingly worthy of the attention of health care practitioners who treat Medicaid patients in the state. » Read More

There is no doubt that the current administration is pushing to expand the Medical Marijuana Program (MMP) in New Jersey.  Since Gov. Murphy took office this year, the number of patients registered has doubled.  The addition of five qualifying debilitating conditions and medical marijuana being viewed as a means to combat the opioid epidemic, are two of the reasons for the drastic increase in patient numbers. » Read More

According to the Office of Inspector General (OIG), the government’s primary civil tool for addressing health care fraud is the False Claims Act (FCA).  Most FCA cases are resolved through settlement agreements in which the government alleges fraudulent conduct and the settling parties do not admit liability. » Read More

The Office of Inspector General (OIG) recently posted a video entitled “Eye on Oversight Video: Corporate Integrity Agreements” that describes how providers accused of false claims or other health care fraud may settle their cases by entering into a Corporate Integrity Agreement (CIA) with the OIG. » Read More

In a recent press release, the United States Attorney’s Office for the Northern District of New York announced that a Poughkeepsie physician and his wife were sentenced for a misdemeanor for ordering and administering to patients, drugs that were not approved by the FDA and were obtained from foreign sources. » Read More

The Office of the Medicaid Inspector General (“OMIG”) has released its Work Plan for the next Fiscal Year, which encompasses April 1, 2018, through March 31, 2019.  The stated mission of the OMIG, an independent entity created within the New York State Department of Health, is to detect and prevent fraudulent practices within the Medicaid system and recover funds deemed improperly paid to health care providers. » Read More

Last May, the New Jersey Supreme Court issued its ruling in Allstate Insurance Company vs. Northfield Medical Center, P.C., et al., finding that a medical practice’s relationship with a management company resulted in violations of that state’s Insurance Fraud Prevention Act (“IFPA”). » Read More

Physicians should be aware of the risks that accompany entering into arrangements with third-party diagnostic testing entities, also known as Mobile Diagnostic Testing Companies (“MDTC”).  Increasingly prevalent in recent years, MDTCs typically offer to perform certain diagnostic tests for physicians’ patients at his/her practice location. » Read More