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.

Attention Medicaid Managed Care/CHIP Program Providers: You Must Enroll in the Medicaid Program Effective 01/01/2018

Effective January 1, 2018, federal law requires that all Medicaid Managed Care Network providers, as well as all Children’s Health Insurance Program providers, enroll with state Medicaid programs.  For example, this applies to a provider that currently participates in a network with a New York State Medicaid managed care plan that provides services to, or […]

Medical Answering Services, LLC Awarded Contract for Medicaid Transportation Services Management in the New York City Region

As of April 23, 2017, Medical Answering Services, LLC (MAS) will serve as the Medicaid transportation manager for the New York City region.  This region includes New York, Kings, Richmond, Queens, and Bronx counties.   MAS currently serves 2,000,000 Medicaid enrollees in 55 counties in the Hudson Valley, Finger Lakes, Northern New York, and Western New […]

Federal False Claims Act Recoveries Are the Third Highest in History

The United States Department of Justice (“DOJ”) reported that it obtained over $4.7 billion in civil settlements and judgments involving federal False Claims Act fraud and abuse claims against the government in 2016. This is the third highest yearly total since the False Claims Act was enacted during the Civil War to help deter fraud […]

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.