On July 15, 2025, the Centers for Medicare & Medicaid Services (CMS) released an Audit and Enforcement Report summarizing its annual Medicare Advantage (Part C) and Prescription Drug (Part D) program audits and enforcement...more
7/23/2025
/ Audits ,
Centers for Medicare & Medicaid Services (CMS) ,
Civil Monetary Penalty ,
Enforcement Actions ,
Enforcement Statistics ,
Medicare ,
Medicare Advantage ,
Medicare Part C ,
Medicare Part D ,
Penalties ,
Prescription Drugs ,
Regulatory Requirements
On June 2, 2025, the Department of Health and Human Services Office of Inspector General (HHS-OIG) announced the release of its Spring 2025 Semiannual Report to Congress. Covering the period from October 1, 2024, to March 31,...more
6/5/2025
/ Centers for Medicare & Medicaid Services (CMS) ,
Criminal Investigations ,
Department of Health and Human Services (HHS) ,
Enforcement Actions ,
False Claims Act (FCA) ,
Fraud Abuse and Waste ,
Government Agencies ,
Healthcare Fraud ,
Information Reports ,
Investigations ,
Medicare ,
Medicare Advantage ,
OIG
On March 26, 2025, the U.S. Department of Justice (DOJ) announced that it settled a False Claims Act (FCA) action against a California-based healthcare provider and a separate radiology group for allegedly submitting and...more
The U.S. Department of Justice (DOJ) recently announced a rare criminal indictment involving the Medicare Advantage program—a contrast from DOJ’s more typical use of its civil enforcement authority to pursue similar issues...more
11/17/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Cooperation ,
Criminal Prosecution ,
Declination ,
Department of Justice (DOJ) ,
False Claims Act (FCA) ,
Fraud ,
Indictments ,
Medicare ,
Medicare Advantage ,
Medicare Advantage Organizations (MAOs) ,
Medicare Part C ,
Voluntary Disclosure
On January 25, 2022, in United States ex rel. Sheldon v. Allergan Sales, LLC, a divided panel of the U.S. Court of Appeals for the Fourth Circuit held that a defendant accused of violating the False Claims Act (FCA) by...more