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.

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 […]

Office of The Medicaid Inspector General Releases 2015-2016 Work Plan

The New York State Office of the Medicaid Inspector General (“OMIG”) has released its State Fiscal Year 2015-2016 Work Plan.  The Work Plan is a road map of where the OMIG intends to go in terms of its anti fraud, waste and abuse efforts with respect to the Medicaid program. The OMIG’s stated mission is […]

Attention DSRIP Performing Provider System Leads: OMIG Highlights Special Considerations for Compliance Plans

The New York State Office of the Medicaid Inspector General (“OMIG”) has released Compliance Guidance for use by DSRIP (Delivery System Reform Incentive Payment)  Performing Provider System (“PPS”) Leads who are in the process of developing and implementing a compliance program.  The document highlights special considerations PPS Leads should contemplate for each of the eight […]

HHS Looks to Collect $12 Million from New York State for Unallowable Continuous 24-Hour Personal Care Services

In 2011, the United States Department of Health and Human Services Office of the Inspector General (“HHS OIG”) investigated New York City’s Medicaid claims for continuous 24-hour personal care services, an area that previous HHS OIG audits consistently identified as one vulnerable to  fraud, waste, and abuse.

New York State’s Medicaid Fraud Control Unit by the Numbers

Medicaid Fraud Control Units (“MFCUs”) have a responsibility to combat Medicaid fraud and patient abuse and neglect.  Toward that end, each MFCU maintains statistical data as to the number of investigations, indictments, and convictions by the MFCUs, as well as the amount of monetary recoveries for both civil and criminal cases.  Each year, a summary […]