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 July 2, 2025, the Department of Justice (“DOJ”) and the Department of Health and Human Services (“HHS”) announced a joint DOJ-HHS False Claims Act Working Group (the “Working Group”) that will focus on enhanced enforcement...more
7/8/2025
/ Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Drug Pricing ,
Enforcement Actions ,
Enforcement Priorities ,
False Claims Act (FCA) ,
Healthcare ,
Healthcare Fraud ,
Medicaid ,
Medical Devices ,
Medicare ,
Working Groups
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 June 6, 2024, the US Supreme Court decided Becerra v. San Carlos Apache Tribe and Becerra v. Northern Arapaho Tribe (Nos. 23-250 and 23-253), holding that the Indian Health Service (IHS) must reimburse Native nations,...more
6/12/2024
/ Becerra v San Carlos Apache Tribe ,
Claim Procedures ,
Health Insurance ,
Indian Health Service (IHS) ,
Medicaid ,
Medical Reimbursement ,
Medicare ,
Native American Issues ,
SCOTUS ,
Statute of Limitations ,
Tribal Government Programs ,
Tribal Governments
In October, the U.S. Department of Justice announced a rare criminal indictment involving the Medicare Advantage program — a contrast from the DOJ's more typical use of its civil enforcement authority to pursue similar issues...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 June 1, 2023, the Supreme Court decided a pair of closely watched False Claims Act (FCA) cases, U.S. ex rel. Schutte v. SuperValu Inc., No. 21-1326, and U.S. ex rel. Proctor v. Safeway, Inc., No. 22-111....more
6/5/2023
/ Drug Pricing ,
False Claims Act (FCA) ,
Materiality ,
Medicaid ,
Medicare ,
Misrepresentation ,
Objective Falsity ,
Pharmacies ,
Prescription Drugs ,
Safeco Insurance Co of America v Burr ,
Scienter ,
SCOTUS ,
Subjective Standard ,
Universal Health Services Inc v United States ex rel Escobar ,
US ex rel Thomas Proctor v Safeway Inc ,
US ex rel Tracy Schutte et al v SuperValu Inc et al