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Department of Justice (DOJ) Insurance Industry

Husch Blackwell LLP

Personal Liability Risks for Insurance Liquidators: Navigating Federal Super Priority in Insolvency Proceedings

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Insurance commissioners serving as liquidators of insolvent insurance companies should be mindful of the potential for personal liability arising under the Federal Priority Act (FPA) and potential solutions through model...more

Epstein Becker & Green

The Record-Setting First National Health Care Fraud Takedown of the Second Trump Administration: What Stayed the Same and What is...

Epstein Becker & Green on

On June 30, 2025, the U.S. Department of Justice (“DOJ”), together with the U.S. Department of Health and Human Services Office of Inspector General (“HHS OIG”) and other law enforcement partners, announced the results of the...more

BakerHostetler

DSIR Deeper Dive: Artificial Intelligence - Banner Years (and Counting) for AI Guidance and Regulation

BakerHostetler on

The period of 2024-2025 was significant for AI law, regulation, and guidance, beginning in early February 2024, and the news told the tale...more

Arnall Golden Gregory LLP

Health Insurers Under Fire: New Administration Cracks Down on Evasive Pricing Practices

Health insurance regulations are rapidly shifting with unprecedented intensity. Amid growing public outrage over evasive and abusive pricing practices by insurers and years of federal underenforcement, the new administration...more

Cozen O'Connor

Justice Department Continues Pattern of False Claims Act Suits Due to Alleged Kickbacks

Cozen O'Connor on

On May 1, the federal government brought a False Claims Act (“FCA”) suit against three health insurers, as well as three insurance brokers. The Justice Department’s suit alleges that the insurers paid millions of dollars in...more

Ropes & Gray LLP

Medicare Advantage Fraud and Abuse: A Bipartisan Enforcement Priority

Ropes & Gray LLP on

Early signs from the initial months of the Trump administration indicate that fraud and abuse enforcement related to the Medicare Advantage program (“MA”) remains a bipartisan focus, as evidenced by the recent statements from...more

Fennemore

Regulatory Landscape of Insurance Claims Denial Practices and Suggestions for a Path Forward to a Sustainable Healthcare Future

Fennemore on

In the wake of the December 4, 2024 fatal shooting of UnitedHealthcare’s CEO Brian Thompson, questions were raised about insurance claim denial practices. Several news outlets noted that UnitedHealth Group’s profits have been...more

Pietragallo Gordon Alfano Bosick & Raspanti,...

The Medicare Advantage Program: Public Money & Private Insurance Companies

When I investigated and litigated False Claims Act (FCA) cases at the U.S. Department of Justice (DOJ) over the last 10 years, I was often surprised by just how little I knew about the broad array of government agencies and...more

Bass, Berry & Sims PLC

International Trade Enforcement Roundup – November 2024

Bass, Berry & Sims PLC on

You are reading the November 2024 Update of the Bass, Berry & Sims Enforcement Roundup, where we bring notable enforcement actions, policy changes, interesting news articles, and a bit of our insight to your inbox. -...more

McAfee & Taft

Gavel to Gavel: Justice Department takes aim at private health plan fraud

McAfee & Taft on

Historically, the U.S. Department of Justice has directed its efforts on combatting healthcare fraud by focusing on persons and companies who defraud or attempt to defraud federally funded healthcare programs, such as...more

Goldberg Segalla

Healthcare Insurers Take Note: New Federal Whistleblower Program is Coming for You

Goldberg Segalla on

Late this past summer, the Department of Justice (DOJ) launched a new initiative to crackdown on corporate misconduct. Beginning August 1, whistleblowers can submit original information to the DOJ regarding various types of...more

Adams & Reese

Hurricane Helene Federal Disaster Recovery Funding

Adams & Reese on

Almost exactly two years to the day from when Hurricane Ian (Category 4) struck Florida’s western coast near Cayo Costa, Florida, on Sept. 26, 2024, Hurricane Helene, also a catastrophic Category 4 storm with winds topping...more

Goodwin

Reliance on Third-Party “Pricing” Facilitators Under Increasing Antitrust Scrutiny

Goodwin on

In the past year, healthcare systems and providers across the country have filed a series of antitrust lawsuits against MultiPlan Inc. and major US health insurers, alleging a hub-and-spoke conspiracy to fix and reduce...more

Cozen O'Connor

The State AG Report – 09.05.2024

Cozen O'Connor on

Here are curated AG and federal regulatory news stories highlighting key areas in which state and federal regulators’ decisions are having an impact across the US: •FTC and Florida AG Put the Brakes on Alleged “Trucking...more

Lowenstein Sandler LLP

Closing Coverage Gaps: California Court Emphasizes the Importance of Coordinated Insurance Policies in Complex Claims Environments

Policyholders must be vigilant in coordinating their insurance program across coverage lines in today’s complex claims environment. Often resembling a “patchwork quilt” – modern businesses protect against a wide range of...more

Pillsbury - Policyholder Pulse blog

Narrowing the Professional Services Exclusion: Policyholder Lessons “Arising Out of” Practice Fusion v. Freedom Specialty...

A recent decision by a California appellate court in Practice Fusion, Inc. v. Freedom Specialty Insurance Company, denying the policyholder more than $118 million in Directors & Officers liability coverage based on an...more

Wiley Rein LLP

Seventh Circuit Holds Settlement Arising From Alleged False Claim Act Violations Does Not Necessarily Constitute Uninsurable...

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The United States Court of Appeals for the Seventh Circuit, applying Illinois law, has held that a $100 million settlement between the United States government and a pharmaceutical company for claims arising under the False...more

Wiley Rein LLP

Claims Arising from Undisclosed Circumstances Barred by Exclusion in Application

Wiley Rein LLP on

The United States Court of Appeals for the Sixth Circuit, applying Ohio law, has held that a warranty exclusion barred coverage for a claim arising from circumstances that were not disclosed in an insured’s application for...more

Farella Braun + Martel LLP

A Promise To Pay Is Just That: Two Courts Reject Insurers’ Bids To Escape Their Coverage Obligations by Complaining About Third...

An insurer in Washington could not eliminate its coverage obligation based on its insured’s recovery from a third party. T-Mobile USA, Inc. v. Steadfast Ins. Co., et al., No. 82704-9-I, 2022 WL 17246715 (Wash. Ct. App., Nov....more

Wiley Rein LLP

Kentucky Supreme Court Holds Prior Notice Exclusion Does Not Bar Coverage for Claims Related to Investigation Noticed and Accepted...

Wiley Rein LLP on

Applying Kentucky law, the Kentucky Supreme Court has held that a prior notice exclusion did not bar coverage for a claim related to a government investigation noticed and accepted by a prior insurer because the insurers were...more

Mintz - Health Care Viewpoints

DOJ Charges 10 Defendants for Allegedly Defrauding Public and Private Health Insurers Out of $11.1 Million Through Business Email...

On November 18, 2022, the U.S. Department of Justice (DOJ) announced charges against 10 defendants in its first coordinated action against individuals using business email compromise (BEC), money laundering, and wire fraud...more

ArentFox Schiff

Harvard, Like Many Students, Misses Application Deadline, Resulting in a $15 million Insurance Coverage Error

ArentFox Schiff on

Harvard University must pay its own defense costs in the ongoing legal challenges to its affirmative action program after losing a battle with its insurance carrier, Zurich American Insurance Company (Zurich)....more

Faegre Drinker Biddle & Reath LLP

Members of Congress Continue to Press DOJ on Health and Dental Insurance Antitrust Enforcement

Congressional leaders continue to seek information from the U.S. Department of Justice (DOJ) concerning the DOJ’s efforts to enforce the Competitive Health Insurance Reform Act (CHIRA), which partially repealed the...more

Hinshaw & Culbertson - Insights for Insurers

DOJ and EPA Announce Comprehensive Strategy to Hand Out Environmental Justice Nationwide

The grip of the "all of government" approach to sustainability continues to tighten. Via a May 5, 2022 memorandum from the Associate Attorney General of the United States, the Department of Justice (DOJ) and the U.S....more

Cozen O'Connor

Ninth Circuit Affirms Application of Goods & Products Exclusion

Cozen O'Connor on

On March 9, 2022, the U.S. Court of Appeals for the Ninth Circuit, in Sentynl Therapeutics, Inc. v. U.S. Specialty Ins. Co, 2022 WL 706941 (9th Cir. Mar. 9, 2022) (applying California law), affirmed a district court’s holding...more

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