News & Analysis as of

Fraud False Claims Act (FCA) Medicare Advantage

Fraud is the making of false representations or engaging in deceptive behavior in order to unlawfully secure financial or personal gain. 
Rivkin Radler LLP

DOJ Targeting Healthcare for False Claims Act Enforcement

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An article in the August issue of Healthcare Risk Management, “DOJ Targeting Healthcare for False Claims Act Enforcement,” discussed recent enforcement activity by the U.S. Department of Justice (DOJ) under the False Claims...more

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

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

Dorsey & Whitney LLP

DOJ Intends to “Aggressively” Enforce the False Claims Act During Second Trump Administration

Dorsey & Whitney LLP on

Deputy Assistant Attorney General Michael Granston laid out the Department of Justice’s (“DOJ”) priorities over the next four years at the Federal Bar Association’s annual qui tam conference in Washington, D.C. last week....more

Lowenstein Sandler LLP

Robust False Claims Act Results for DOJ in 2024 Reveal Dynamic Enforcement Landscape

In January, the Department of Justice (DOJ) announced that settlements and judgments under the False Claims Act (FCA) exceeded $2.9 billion in fiscal year 2024, bringing the total amount of settlements and judgments under the...more

K&L Gates LLP

US Department of Justice Announces US$2.9 Billion in Fiscal Year 2024 False Claims Act Recoveries

K&L Gates LLP on

On 15 January 2025, the US Department of Justice (DOJ) published its report (Report) announcing civil recoveries under the False Claims Act (FCA) for Fiscal Year (FY) 2024. The recoveries for FY 2024 exceeded US$2.9 billion,...more

Ropes & Gray LLP

False Claims Act Insights: Key Takeaways from DOJ’s Fiscal Year 2024 Cases & Recoveries

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The U.S. Department of Justice (DOJ) announced last Wednesday that settlements and judgments under the False Claims Act (FCA) exceeded $2.9 billion in fiscal year 2024—up approximately 5% from last year. DOJ’s announcement...more

Wiley Rein LLP

DOJ Announces Larger FCA Recoveries and More Whistleblower Cases Filed in 2024

Wiley Rein LLP on

On January 15, 2025, the U.S. Department of Justice (DOJ) announced $2.9 billion in total False Claims Act (FCA) recoveries for FY 2024, a slight increase from 2023. In addition to growing recoveries, DOJ announced a new...more

ArentFox Schiff

Investigations Newsletter: DOJ Reports Nearly $3 Billion in FCA Settlements, Judgments for FY 2024

ArentFox Schiff on

DOJ Reports Nearly $3 Billion in FCA Settlements, Judgments for FY 2024 - On January 15, the US Department of Justice (DOJ) reported that settlements and judgments under the False Claims Act (FCA) totaled more than $2.9...more

Foley Hoag LLP

Health Care Fraud Enforcement in 2025

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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

Stevens & Lee

After the Whistle: Constitutional Challenges to Qui Tam Actions

Stevens & Lee on

Whenever there is a pot of money up for grabs, people will inevitably want more than their fair share. And when that money is doled out through government contracts, opportunities for fraud abound. The government can...more

Proskauer - Health Care Law Brief

Relator, No More?  Florida Federal Court Declares Qui Tam Provisions of False Claims Act Unconstitutional, with Potentially Broad...

On September 30, 2024, the U.S. District Court for the Middle District of Florida issued an order dismissing a qui tam case under the False Claims Act (“FCA”) and holding the relator provisions of the FCA to be...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

Bass, Berry & Sims PLC

Martin’s Point Health Care Inc.’s $22.4M Settlement Illustrates DOJ’s Focus on Part C Fraud

Bass, Berry & Sims PLC on

Last week, the U.S. Department of Justice (DOJ) announced a $22.4 million settlement resolving allegations that Martin’s Point Health Care, Inc. (Martin’s Point) violated the False Claims Act (FCA) by submitting inaccurate...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

ArentFox Schiff

Investigations Newsletter: DOJ Secures $5.6 Billion in False Claims Act Recoveries in Fiscal Year 2021 

ArentFox Schiff on

DOJ Secures $5.6 Billion in False Claims Act Recoveries in Fiscal Year 2021 - On February 1, 2022, the U.S. Department of Justice (DOJ) announced that the Department recovered approximately $5.6 billion in False Claims Act...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

Sheppard Mullin Richter & Hampton LLP

DOJ Issues New Guidance on the Evaluation of Corporate Compliance Programs in Federal Fraud Investigations

On February 8th, the U.S. Department of Justice (DOJ) quietly issued new guidance on how the agency evaluates corporate compliance programs during fraud investigations. The guidance, published on the agency’s website as the...more

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