On December 11, 2024, the U.S. Department of Health and Human Services, Office of the Inspector General (OIG) published a Special Fraud Alert in response to the uptick in abusive marketing practices between Medicare Advantage Organizations (MAOs), health care providers, and ancillary participants (such as agents and brokers).
On February 4, 2025, the New York State Assembly Health Committee will vote on legislation that proposes to increase the penalties for violations of the State Public Health Law (PHL), with an increased maximum penalty specifically for Article 28 hospitals and nursing homes. The justification for this proposed measure is that current monetary penalties for PHL violations are “outdated” and “nonthreatening” and merely regarded as the “cost of doing business.”
On January 21, 2025, New York Governor Kathy Hochul released the proposed FY 2026 New York State Executive Budget, which includes enhanced scrutiny of material transactions involving health care entities.
The United States Court of Appeals for the Second Circuit (Second Circuit or Court), which has Federal jurisdiction in Connecticut, New York, and Vermont, recently issued an important decision regarding health care provider liability under the False Claims Act (FCA) when a whistleblower alleges a violation of the Anti-Kickback Statute (AKS). The Second Circuit explicitly adopted the “one purpose” test for the first time to determine whether a financial arrangement between a provider and a referral source violates the AKS, and thus potentially subjects the parties to substantial fines and penalties under the FCA.
Garfunkel Wild’s Legislative Session Update newsletter provides updates on relevant legislation introduced in New York State, particularly involving hospitals and long term care facilities.