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False Claims Act (FCA) Fraud Centers for Medicare & Medicaid Services (CMS)

Womble Bond Dickinson

2025 National Health Care Fraud Takedown Sets Record as Largest in U.S. History, Charging 324 Defendants for Over $14.6 Billion in...

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On June 30, 2025, the Department of Justice announced the results of its 2025 National Health Care Fraud Takedown (“2025 Takedown”). ...more

Sheppard Mullin Richter & Hampton LLP

Proving Fraud is and Should Be Hard: Lessons from a Recent Medicare Advantage False Claims Act Decision

The litigator’s adage “it’s easy to plead, it’s hard to prove” once again came true in the long-running False Claims Act (FCA) case targeting Medicare Advantage (“MA”) plans operated by UnitedHealth (United). Eight years...more

Rivkin Radler LLP

Online DME Company Billed Insurers for Unnecessary Medical Supplies

Rivkin Radler LLP on

DMERx, an online DME platform, served as the basis for a massive fraud against Medicare and other insurers. Gregory Schreck, a Kansas man who was the vice president of DMERx, orchestrated a sophisticated fraud scheme to bill...more

Foley Hoag LLP

Health Care Fraud Enforcement in 2025

Foley Hoag LLP on

We kick off our annual Year in Preview series with a comprehensive look at health care fraud enforcement in 2025. This post proceeds in three parts. First, we explore what the second Trump administration might bring, looking...more

Hendershot Cowart P.C.

Doctors: Don’t Fall Victim To Telemedicine Fraud Schemes

Hendershot Cowart P.C. on

Telemedicine companies are supposed to facilitate medically necessary services to beneficiaries over the telephone via licensed medical professionals. In reality, however, many of these “telemedicine companies” are...more

Mintz

EnforceMintz — DOJ’s Continued Focus on Individual Accountability

Mintz on

As discussed in EnforceMintz – Significant 2022 Regulatory and Policy Developments, the Department of Justice (DOJ) issued several memoranda in late 2022 and early 2023, reinforcing DOJ’s approach to individual accountability...more

Mintz

EnforceMintz — 2023 Brings Uptick in Cybersecurity Enforcement, Insight Into Potential Risks

Mintz on

After the Department of Justice (“DOJ”) announced its Civil Cyber-Fraud Initiative in October 2021, many in the False Claims Act (“FCA”) bar expected an onslaught of enforcement actions and qui tam cases. The initiative...more

WilmerHale

Criminal Indictment for Medicare Advantage Fraud

WilmerHale on

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

ArentFox Schiff

Investigations Newsletter: Medical Marketer Convicted of $55 Million Fraud Scheme

ArentFox Schiff on

Medical Marketer Convicted of $55 Million Fraud Scheme - Late last week, a federal jury in the Northern District of Texas convicted Quintan Cockerell for his role in a $55 million fraud conspiracy involving TRICARE, a...more

McDermott Will & Schulte

SuperValu: It’s Not Super Bad! A Practical Look at the Supreme Court’s Recent FCA Scienter Ruling

Two separate lawsuits alleging False Claims Act (FCA) violations by retail drug pharmacies made their way to the Supreme Court of the United States this term. The lawsuits decided whether the pharmacies could defeat these...more

McDermott Will & Schulte

Healthcare Regulatory Check-Up Newsletter | April 2023 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights significant regulatory activity for April 2023. We discuss several criminal and civil enforcement actions related to the Anti-Kickback Statute (AKS) and the...more

BCLP

U.S. Health Care Industry Takes Note: U.S. Supreme Court 2023 Attention on False Claims Act

BCLP on

This Tuesday, April 18, 2023, the U.S. Supreme Court heard argument in U.S. v. SuperValu. SuperValu is the second – and more consequential – False Claims Act (FCA) case of the term....more

McDermott Will & Schulte

Healthcare Regulatory Check-up Newsletter | January 2023 Recap

This issue of McDermott’s Healthcare Regulatory Check-Up highlights significant regulatory activity and developments occurring in January 2023, including several criminal and civil enforcement actions related to the federal...more

Mintz - Health Care Viewpoints

EnforceMintz — With Telemedicine Here to Stay, Enforcement Agencies Continued their Scrutiny

The Department of Justice and other federal enforcement agencies continued to hotly pursue individuals and entities involved in criminal telefraud schemes in 2022, as evidenced by the national coordinated law enforcement...more

Benesch

Dialysis & Nephrology Digest - January 2023

Benesch on

Federal omnibus spending bill rolls back some Medicare payment cuts scheduled for 2023, 2024 - Buried within the $1.7-trillion spending package signed by the President on Dec. 29 was partial relief for a planned 4.5% cut...more

Foley & Lardner LLP

Court Calls Underlying Legal Standards “No Model of Clarity” but Allows False Claims Act Case To Proceed Anyway

Foley & Lardner LLP on

Does violating requirements amount to fraud under the False Claims Act (FCA) when the requirements allegedly violated are unclear? There is currently a circuit split and petitions for review pending to the Supreme Court as to...more

Hendershot Cowart P.C.

Healthcare Providers: You May Be Liable for Billing Company Fraud, Negligence

Hendershot Cowart P.C. on

Physicians and practice managers: Keep an eye on medical billing or health services contractors acting on your behalf. Your practice is liable for any violations of state and federal healthcare fraud laws, including Stark...more

Bass, Berry & Sims PLC

False Claims Act Fundamentals: Self-Disclosures

Bass, Berry & Sims PLC on

When healthcare providers and other government contractors are subject to scrutiny for bills submitted to the government, it is often the result of a whistleblower complaint filed under the qui tam provisions of the False...more

Gardner Law

Anti-Fraud & Sunshine Update

Gardner Law on

Staying up-to-date with fraud enforcement trends and recent cases and settlements can sometimes be viewed as a “Glass Half Empty” perspective, focusing on negative aspects of the industry and the perceived threat of...more

Foley & Lardner LLP

Managed Care & the FCA: Are Courts Getting It Right?

Foley & Lardner LLP on

Courts are grappling with unique questions in the context of managed care programs in False Claims Act (FCA) cases. But are they getting it right? Two questions trending in courts relate to: (1) materiality under the FCA when...more

Harris Beach Murtha PLLC

OIG Enforcement Summary: August 1, 2022 – August 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. The enforcement actions reported are...more

Greenbaum, Rowe, Smith & Davis LLP

DOJ and Federal Law Enforcement Agencies Coordinate Efforts in Expanded Pursuit of Healthcare-Related COVID-19 Fraud

What You Need to Know •The federal government is broadening its multi-agency law enforcement effort to address pandemic-related fraud beyond PPP-related cases to encompass alleged instances of healthcare-related COVID-19...more

Bass, Berry & Sims PLC

2021 Recap: Hospitals’ Significant False Claims Act Settlements

Bass, Berry & Sims PLC on

Each year, the Department of Justice (DOJ) recovers millions of dollars through False Claims Act (FCA) settlements, and 2021 was no exception. Some of the most sizeable or otherwise noteworthy settlements from 2021 were with...more

King & Spalding

DOJ Alleges Kaiser Defrauded Medicare Out of $1 Billion

King & Spalding on

On October 25, 2021, DOJ intervened in a False Claims Act (FCA) case against Kaiser Permanente, Kaiser Foundation Health Plan, Inc., and certain Permanente Medical Groups (Kaiser). In its complaint, DOJ contends that Kaiser...more

Foley & Lardner LLP

PE Firm Pays Record Settlement for Allegedly Deficient Health Services: Identifying Traps for the Unwary

Foley & Lardner LLP on

In a Press Release issued on October 14 2021 by the Office of Massachusetts Attorney General Maura Healy, a potentially groundbreaking settlement was announced. Below is an excerpt from the release, followed by our takeaways....more

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