The New York State Office of the Medicaid Inspector General (“OMIG”) recently finalized regulatory changes to New York State law which relate to the withholding of payments to Medicaid providers when there is a “credible allegation of fraud.” A credible allegation of fraud is defined as an “allegation that has indicia of reliability and has
Health Systems as Providers and Insurers
Historically, health care services have been paid for by health insurance companies which accept monthly premium payments from employer groups and individuals. The premium for defined health care services is due whether the insureds under the policy use the benefits or not. Built into the premiums are additional administrative costs including fees paid to insurance
The False Claims Act and Federal Grants
In United States ex rel. Feldman v. van Gorp , decided last week, the Second Circuit ruled on an issue of first impression concerning False Claims Act (“FCA”) damages in the context of a federal grant for medical research funding, and also addressed the FCA’s materiality standard.
In Feldman, Cornell University and a psychiatry