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Department of Justice (DOJ) Medicare Advantage Office of the Inspector General

Holland & Knight LLP

HHS and DOJ Revitalize False Claims Act Working Group

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The U.S. Department of Health and Human Services (HHS) and U.S. Department of Justice (DOJ) on July 2, 2025, announced their intent to strengthen the DOJ-HHS False Claims Act Working Group. The announcement emphasized...more

King & Spalding

Trump Administration Revamps Working Group to Focus on False Claims Act

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On Wednesday, July 2, 2025, HHS and DOJ announced a new working group focused on enforcement of the False Claims Act (“FCA”). According to the announcement, the DOJ-HHS False Claims Act Working Group (“Working Group”) is a...more

Wiley Rein LLP

DOJ Health Care Fraud Takedown and FCA Working Group Signal New Era of Enforcement and Compliance Risks

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On July 2, 2025, the U.S. Department of Justice (DOJ) and the Department of Health and Human Services (HHS) jointly announced the next phase of the Administration’s “Whole-of-Government” approach to fighting health care...more

Ropes & Gray LLP

[Podcast] Medicare Advantage: Enforcement Activity & Broker Arrangements

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On this Ropes & Gray podcast, health care partner Michael Lampert and counsel Sam Perrone are joined by litigation & enforcement partner Andrew O’Connor for a two-part discussion, with this first episode focused on recent...more

Health Care Compliance Association (HCCA)

[Event] Healthcare Basic Compliance Academy - July 21st - 24th, Nashville, TN

Grounded in the OIG’s General Compliance Program Guidance and DOJ’s Evaluation of Corporate Compliance Programs, our immersive, three-and-a-half-day, classroom-style Healthcare Basic Compliance Academy equips compliance...more

Cozen O'Connor

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

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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

Bass, Berry & Sims PLC

Seoul Medical Group and Renaissance Imaging Medical Associates Settle Medicare Risk Adjustment Fraud Case for $62 Million

Bass, Berry & Sims PLC on

The Department of Justice announced this week that California-based primary care provider Seoul Medical Group, Inc. (SMG), SMG’s former president and majority owner, and California-based radiology group Renaissance Imaging...more

Mintz - Health Care Viewpoints

EnforceMintz — FCA Enforcement in Value-Based Care Arrangements Heated Up in 2024 and Likely to Remain a Priority in 2025

Value-based care (VBC) is a health care delivery model that has grown increasingly common in recent years. Perhaps unsurprisingly, this growth seems to have attracted the attention of government enforcement agencies...more

Mintz - Health Care Viewpoints

EnforceMintz — Medicare Advantage and Part D Programs to Remain in the Enforcement Spotlight in 2025

As government scrutiny and enforcement targeting the Medicare Advantage (Medicare Part C) program continued in 2024, the industry’s response to agency actions escalated. Last year also resulted in the first sizable Part D...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

Stevens & Lee

Special Fraud Alert: Suspect Payments in Marketing Arrangements Related to Medicare Advantage and Providers

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On Dec. 11, 2024, the OIG issued a Special Fraud Alert (Alert) related to certain fraud and abuse risks associated with marketing arrangements between Medicare Advantage Organizations (MAOs) and health care professionals...more

Proskauer - Health Care Law Brief

OIG Releases Special Fraud Alert About Suspect Payments in Marketing Arrangements Related to Medicare Advantage and Providers

On December 11, 2024, the Office of Inspector General for the U.S. Department of Health and Human Services (“OIG”) issued a special fraud alert warning about certain marketing schemes that involve questionable payments and...more

Sheppard Mullin Richter & Hampton LLP

Increased Scrutiny into Agents & Brokers in the Medicare Advantage Space

Most Medicare Advantage (“MA”) beneficiaries rely on agents and brokers to help them navigate the complex process of selecting a health plan that will meet their needs. In exchange, brokers and agents received certain fixed...more

Jones Day

2023 False Claims Act Enforcement in Health Care and Life Sciences, Part II

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In February 2024, the Department of Justice (“DOJ”) announced the results of its 2023 False Claims Act (“FCA”) enforcement efforts. Through those efforts, it obtained more than $2.6 billion in overall recoveries, and of that...more

Jones Day

2023 False Claims Act Enforcement in Health Care and Life Sciences, Part I

Jones Day on

In February 2024, the Department of Justice (“DOJ”) announced the results of its 2023 False Claims Act (“FCA”) enforcement efforts. Through those efforts, the government obtained more than $2.6 billion in overall recoveries,...more

Mintz

EnforceMintz — Government Scrutiny of Medicare Advantage Organizations Expected to Continue in 2024

Mintz on

Medicare Advantage (also known as Medicare Part C) remains a top enforcement priority as evidenced by False Claims Act (FCA) investigations and litigation involving nearly all large Medicare Advantage Organizations (MAOs). As...more

American Conference Institute (ACI)

[Event] 2nd Annual Legal, Regulatory and Compliance Summit on Medicare Advantage - November 2nd - 3rd, Nashville, TN

Hosted by American Conference Institute, the 2nd Annual Legal, Regulatory and Compliance Summit on Medicare Advantage returns for another exciting year with curated programming that will address the latest oversight and...more

Harris Beach Murtha PLLC

HHS Office of Inspector General August 2023 Enforcement Activity

The following is a summary of selected federal Department of Health and Human Services’ Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country. The enforcement actions reported...more

Mintz - Health Care Viewpoints

EnforceMintz — Medicare Advantage Remains a Top Enforcement Priority

Medicare Advantage (Medicare Part C) remained a top enforcement priority in 2022, and Medicare Advantage Organizations (MAOs) are the subject of intense scrutiny by the Department of Justice (DOJ); the Office of Inspector...more

Foley & Lardner LLP

Will CMS’s Proposed Rule on “Identified Overpayments” Increase Reverse FCA Cases?

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On December 27, 2022, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule which, in part, seeks to amend the existing regulations for Medicare Parts A, B, C, and D regarding the standard for when an...more

Bradley Arant Boult Cummings LLP

Medicare Advantage Programs’ Increasing Popularity Invites Heightened FCA and Regulatory Scrutiny

As Medicare Advantage attracts more eligible beneficiaries, it is also drawing attention from False Claims Act (FCA) prosecutors. In 2022, enrollment in Medicare Advantage plans reached 28.7 million Medicare beneficiaries, or...more

Harris Beach Murtha PLLC

OIG Enforcement Summary: July 1, 2022 – July 15, 2022

The following is a summary of the federal Department of Health and Human Services’ Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country.[1]  The enforcement actions reported are...more

Holland & Knight LLP

Recent Medicare Advantage Plan Settlement Highlights Anti-Kickback Statute's Breadth

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A recent settlement involving a Medicare Advantage plan should serve as a reminder that the federal Anti-Kickback Statute (AKS) is broad and far-reaching, both on its face and in practice. On July 1, 2022, the U.S. Department...more

Foley & Lardner LLP

OIG Issues Report Suggesting Medicare Advantage Companies Perform Chart Reviews and Health Risk Assessments to Drive Higher...

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On September 20, 2021 the Office of the Inspector General of the U.S. Department of Health and Human Services (OIG) issued a report suggesting that certain Medicare Advantage (MA) companies were leveraging chart reviews and...more

Epstein Becker & Green

The Department of Justice (“DOJ”) Continues its Medicare Advantage (“MA”) Enforcement Efforts with a $90 Million Dollar Settlement...

On August 30, 2021, the DOJ announced a $90 million dollar settlement with Sutter Health and affiliates (“Sutter Health”) to settle False Claims Act (“FCA”) allegations brought by qui tam relator, Kathy Ormsby, related to the...more

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