David Ross

About David Ross

David is Partner and concentrates his practice on Medicaid, Medicare and private insurance audits & investigations, Health Law including fraud and abuse, governmental investigations of all kinds, Medicaid compliance plans and Article 78 cases. He is head of our Government Investigations practice and also works in Healthcare Fraud & Abuse.

US HHS OIG and HCCA Release Compliance Program Effectiveness Resource Guide

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) and the Health Care Compliance Association (HCCA) released Measuring Compliance Program Effectiveness: A Resource Guide on March 27, 2017 (“the Guide”). The Guide was created by the HCCA-OIG Compliance Effectiveness Roundtable which convened in Washington, D.C., in January 2017 to explore ways […]

Medicaid Program Integrity: US GAO Finds CMS Needs Work to Develop More Effective Oversight Efforts

On April 17, 2017, the United States Government Accountability Office (GAO) released a report about the current state of Medicaid program integrity. GAO conducted a study of the Medicaid program due to concerns about improper payments and was asked to conduct a study of the Centers for Medicare & Medicaid Services (CMS) to determine the […]

The OMIG Releases its 2017-2018 Work Plan

The New York State Office of the Medicaid Inspector General (“OMIG”) has released its annual Work Plan for fiscal year 2017-18.  The annual Work Plan offers providers insight into OMIG’s areas of focus in the New York State Medicaid program for the upcoming year.  As stated in the Work Plan, the OMIG’s overall mission “is […]

 CMS Announces RAC Audits To Begin in New York State

The Centers for Medicare and Medicaid Services (CMS) announced that Performant Recovery, Inc., New York’s Medicare Fee-for-Service Recovery Audit Contractor (RAC) for Region 1, can begin recovery audit activity now that provider outreach is complete. Region 1 includes the following groups of states:  J8, WPS: Michigan and Indiana; J15, CGS: Ohio and Kentucky; JK, NGS: New […]

ATTENTION OASAS PROVIDERS: JUSTICE CENTER INCIDENT REPORTING

Recently, the Counsel of OASAS, Robert Kent, sent a memorandum to all providers regarding Justice Center incident reporting policies and procedures for all OASAS providers. OASAS has also published a guidance document for incident reporting to the Justice Center under Part 836 of the OASAS regulations. Many OASAS providers have a process and procedure whereby […]

SCOTUS Decides Implied Certification Issue in Key False Claims Act (Whistleblower) Case

In a decision that is poised to have resonating implications for health services providers, the Supreme Court of the United States explicitly endorsed the “implied false certification theory of liability” under the False Claims Act (FCA) in Universal Health Services, Inc. v.  U.S. ex rel. Escobar.  Under this theory of liability, any person who submits […]

CMS Releases Final Rule on 60-day Medicare Overpayment Reporting Obligations

This morning, the Centers for Medicare and Medicaid Services (“CMS”) made available a copy of a final rule clarifying the obligations of providers and suppliers to report and return Medicare overpayments within 60 days after the date on which the overpayment was identified.  The final rule will be published in tomorrow’s Federal Register.

SAMHSA Submits Proposed Changes to 42 C.F.R. Part 2

Alcoholism, substance abuse and chemical dependency treatment providers should be aware that the Substance Abuse and Mental Health Services Administration (“SAMHSA”) has promulgated proposed changes to regulations regarding the privacy and confidentiality of what are now called “substance use disorder” treatment records.  Those privacy regulations, which are located at 42 C.F.R. Part 2, are well […]

Billing Agent for Healthcare Provider Settles for $500,000 to Resolve TRICARE False Claims Act Case

Today, the Department of Justice U.S. Attorney’s Office for the Northern District of New York announced a settlement with Medical Reimbursement Systems, Inc. (“MRSI”) to resolve allegations that it violated the false claims act.  The press release can be found here. Medical Reimbursement Systems, Inc. provided billing, coding and full revenue cycle services for health care […]

Update: Court Denies Motion to Dismiss Federal Case and Identifies When 60-day Clock for Repayment of Overpayments Begins Ticking

On August 3, 2015, Judge D.J. Ramos of the Southern District of New York denied Healthfirst’s motion to dismiss the United States’ action under the False Claims Act (FCA) and the related state action.  Healthfirst contended in its motion that the government failed to sufficiently plead the case.  Notably, in denying this motion, the court […]