News & Analysis as of

Department of Justice (DOJ) Insurance Industry False Claims Act (FCA)

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

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

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

Wiley Rein LLP

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

Wiley Rein LLP on

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

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

Lowenstein Sandler LLP

In the Know: The Lowenstein Insurance Recovery Group’s Tip of the Month - October 2021

Lowenstein Sandler LLP on

A recent coverage case from Illinois is a helpful reminder to policyholders that they should not take no for an answer when insurers deny a claim based on uninsurability, restitution, disgorgement, or fraud. In fact, those...more

King & Spalding

California Federal Judge Rules Insurer Not Obligated to Pay Los Angeles Hospital’s $42 Million Settlement and Investigation Costs...

King & Spalding on

On February 12, 2019, U.S. District Court Judge Stephen V. Wilson dismissed a suit brought by Pacific Alliance Medical Center (PAMC) alleging, among other counts, breach of contract against its insurer for failure to cover...more

Carlton Fields

Justice Department Recovers Nearly $6 Billion From False Claims Act Cases in 2014

Carlton Fields on

The U.S. Department of Justice (DOJ) obtained a record $5.69 billion in settlements and judgments from civil cases involving fraud and false claims against the government in fiscal year 2014. This marks the first time the DOJ...more

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