Auditing the Auditors? Congressional Panel Requests Federal Audit of New York’s Medicaid Program

As a result of a recent Congressional report on New York State’s Medicaid program, a Congressional panel has requested that federal auditors review New York State’s $54 billion Medicaid spending and fraud, waste and abuse oversight programs. The report of the U.S. House of Representatives Committee on Oversight and Government Reform, entitled “Billions of Federal […]

Medicaid Provider Gets His Second Day In Court, Wins $7.7 Million Verdict Against His Accusers

A Brooklyn dentist who alleged that his career was ruined by a New York State Attorney General’s Office Medicaid Fraud Control Unit (MFCU) investigation has won a $7.7 million verdict against two of then-Attorney General Eliot Spitzer’s staff members. According to court papers filed by Dr. Leonard Morse’s attorney, available here, the dentist was pursued […]

New York State Allegedly Overbilled $15 Billion for State-Operated Facilities for Developmentally Disabled

On May 17, 2012, the U.S. Department of Health and Human Services, Office of Inspector General (OIG) released a report that found Medicaid overpayments to New York State-operated developmental centers. The OIG concluded that, in 2009, State-operated  facilities for the developmentally disabled received $1.7 billion in Medicaid payments in excess of the reported costs of these facilities. […]

Ninth Circuit Court Rules Recovery Audit Contractor’s Decisions to Reopen Medicare Claims For Good Cause Can’t Be Challenged

Two weeks ago the U.S. 9th Circuit Court of Appeals ruled in Palomar Medical Center v. Sebelius that a health care provider is not entitled to challenge the determination of a Medicaid Recovery Audit Contractor (“RAC”) to reopen a Medicare claim for reimbursement for good cause. Palomar had provided inpatient rehabilitation services to a patient following […]

When HIPAA Investigations Broaden To Scrutinize Unrelated Business Practices: The Settlement between the State of Minnesota and Accretive Health

Prosecutions involving breaches of protected health information under the Health Insurance Portability and Accountability Act (“HIPAA”) are becoming more frequent; we have noted recent civil settlements involving providers in Massachusetts and Alaska, as well as a criminal prosecution in California.  The latest prosecution, and resulting settlement, illustrates a new twist: the focus of a data […]

No-Fault Insurance Medical Providers Take Notice: Emergency Rule for No-Fault Insurance Hearings Takes Effect

Providers who care for patients utilizing no-fault insurance should familiarize themselves with an emergency rule promulgated by the Department of Financial Services (“DFS”) that took effect on June 12, 2012. Authorized by Insurance Law § 5109(a) and issued in response to a growing number of law enforcement actions and private lawsuits targeting alleged abuses of […]