News & Analysis as of

Enforcement Actions Health Insurance

Arnall Golden Gregory LLP

Mental Health Parity Enforcement Paused: What Providers and Patients Need to Know

On May 15, 2025, the U.S. Departments of Labor, Health and Human Services, and the Treasury issued a statement related to the enforcement of the Mental Health Parity and Addiction Equity Act (“MHPAEA”)....more

Troutman Amin LLP

WHOA! MASSIVE $140 MILLION JUDGMENT AGAINST ASSURANCE IQ: FTC Slams Assurance IQ for Misleading Health Plan Marketing in Violation...

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The FTC announced today a $100 million judgment against Assurance IQ for alleged deceptive practices targeting consumers seeking health insurance. The FTC initiated the complaint, FTC v. Assurance IQ LLC, U.S. District Court,...more

Husch Blackwell LLP

Employers Continue to Face ERISA Tobacco Surcharge Lawsuits, With Mixed Results

Husch Blackwell LLP on

Recently, companies have seen a spate of class action lawsuits challenging the legality of tobacco cessation wellness programs and related tobacco surcharges imposed by their employer-sponsored health benefit plans....more

Foley & Lardner LLP

CMS Finalizes Rule Change Applying Preponderance of the Evidence Standard to Agent, Broker, and Web-Broker Exchange Agreement...

Foley & Lardner LLP on

In its recently issued Final Rule (CMS-9884-F; 90 FR 27074-01; the Final Rule), the Centers for Medicare and Medicaid Services (CMS) finalized revisions to 45 C.F.R. § 155.220(g)(2) to specify a standard of proof for...more

Cooley LLP

‘Whole-of-Government Approach’ Targets Healthcare Fraud From Every Angle

Cooley LLP on

Just months after the US Department of Justice (DOJ) designated healthcare fraud as one of its key criminal enforcement priorities, two recent announcements underscore the federal government’s continued focus on combating...more

Haynes Boone

False Claims Act - 2025 Mid-Year Review

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The False Claims Act continues to be one of the most commonly used weapons in the government’s enforcement arsenal to address various forms of fraud. In addition to our “Year in Review” publication providing an overview of...more

Vedder Price

DOJ Charges 324 Defendants in Unprecedented Health Care Fraud Takedown

Vedder Price on

On June 30, 2025, the Department of Justice (DOJ) filed criminal charges against 324 defendants across the country alleging participation in various health care fraud schemes. The DOJ identified the operation as the 2025...more

Hendershot Cowart P.C.

Qlarant, Novitas Audits Escalate as Medicare Skin Substitutes Spending Hits $1.6 Billion, CMS Seeks Evidence of Clinical...

Hendershot Cowart P.C. on

The wound care industry faces unprecedented scrutiny as Medicare Part B expenditures for skin substitutes exceeded $1.6 billion in the fourth quarter of 2023 alone. The spending surge has triggered a wave of skin substitute...more

Ballard Spahr LLP

Courts Split on Enforcement of No Surprises Rules

Ballard Spahr LLP on

The Fifth Circuit and the Federal District Court of Connecticut have issued conflicting decisions on whether service providers may sue to enforce arbitration awards under the No Surprises Rules in the Consolidated...more

Troutman Pepper Locke

New York AG Intensifies Investigation and Enforcement Against Alleged Medicaid Fraud

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On June 30, 2025, New York Attorney General (AG) Letitia James announced new lawsuits, criminal charges, and settlements with 25 New York transportation companies related to alleged schemes to defraud Medicaid of millions....more

Epstein Becker & Green

The First National Health Care Fraud Takedown of the Second Trump Administration: What Stayed the Same and What is New?

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

Sheppard Mullin Richter & Hampton LLP

DOJ and HHS Announce Joint False Claims Act Working Group and Enforcement Priorities

On July 2, 2025, the Departments of Justice and Health & Human Services announced a joint working group aimed at “strengthening their ongoing collaboration to advance priority enforcement areas” under the False Claims Act...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

ArentFox Schiff

Federal Courts Divided Over Private Enforcement of ‘No Surprises Act’ Arbitration Awards

ArentFox Schiff on

Congress enacted the No Surprises Act (NSA) to protect patients from unexpected medical bills. A central pillar of the NSA is its independent dispute resolution (IDR) process, under which payers and providers can submit...more

Polsinelli

Five Things Every Health Care Provider Should Know About HHS OIG’s 2025 Semiannual Report

Polsinelli on

On June 2, 2025, the Department of Health and Human Services (HHS), Office of Inspector General (OIG) published its Semiannual Report to Congress. This report covers the period from October 1, 2024, through March 31, 2025,...more

Troutman Pepper Locke

California AG Takes Action Against $1.3 Million Insurance Fraud Scheme

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In May, California’s attorney general (AG) charged a local dermatologist with more than 20 counts of fraud after uncovering a scheme that allegedly resulted in the state’s Medicaid program paying out over $1.3 million for...more

Troutman Amin LLP

SCAMMERS OR DUMMIES?: Selling Limited Benefits Plans to Consumers Seeking Health Insurance Lands Four Dudes In Hot Water–BUT Are...

Troutman Amin LLP on

The lead generation industry is fascinating. If there is one over arching mantra it is this– monetize all data available. And sometimes that can get folks into BIG trouble, especially when lead buyers end up pitching...more

Rivkin Radler LLP

FBI Warns Consumers of Discount Medical Scams

Rivkin Radler LLP on

On April 30, the Federal Bureau of Investigation (FBI) released a Public Service Announcement warning consumers about fraudulent discount medical scams. These scams typically involve deceptive offers for health insurance...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

Troutman Pepper Locke

Arizona AG Secures More Than $30M in Restitution After Obtaining Criminal Conviction in Health Care Fraud Scheme

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On May 8, the Superior Court of Arizona in Maricopa County ordered a health care company to pay more than $30 million in restitution to the Arizona Health Care Cost Containment System (AHCCCS) due to the company’s alleged...more

Bond Schoeneck & King PLLC

Administration Grants Welcome Reprieve From Certain NQTL Requirements

Administration Grants Welcome Reprieve From Certain NQTL Requirements - Earlier this month, the Departments of Labor, Health and Human Services and Treasury (the “Departments”) announced that for the foreseeable future...more

Warner Norcross + Judd

Delayed Enforcement of Mental Health Parity NQTL Comparative Analysis Final Regulations

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Under the Mental Health Parity and Addiction Equity Act (MHPAEA), as amended by the Consolidated Appropriations Act (CAA), 2021, group health plans and health insurance issuers must conduct comparative analyses to show that...more

McDermott Will & Schulte

Enforcement of Mental Health Parity Regulations Suspended: Takeaways for Plan Sponsors and Health Insurance Issuers

In January 2025, The ERISA Industry Committee (ERIC) filed a complaint against the US Departments of Labor, Health and Human Services, and the Treasury (the departments) seeking to invalidate the 2024 final regulations under...more

Foley & Lardner LLP

Mental Health Parity Alert - Non-Enforcement of Final Rules

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The Mental Health Parity and Addiction Equity Act (MHPAEA), and its implementing regulations and guidance, prohibits health insurance policies and group health plans that cover mental health and substance use disorder...more

Amundsen Davis LLC

Court Ruling Hamstrings IRS Enforcement of ACA Employer Mandate

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On April 10, 2025, a federal court in Texas issued an opinion in the case of Faulk Co. v. Becerra that significantly impacts how the Affordable Care Act’s (ACA) employer mandate can be enforced. The ruling effectively...more

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