Data Driven Compliance: The Failure to Prevent Fraud Offense: Insights for US General Counsels with Mike DeBernardis
The State of Healthcare Enforcement
Daily Compliance News: August 21, 2025, The Fabricated Evidence Edition
Data Driven Compliance – James Tillen on the Importance of Cross-Functional Collaboration in Complying with the FTPF Offense
2 Gurus Talk Compliance: Episode 57 — The Tom on His Highhorse Edition
Data Driven Compliance: Understanding the ECCTA and Its Impact with Jonathan Armstrong
10 For 10: Top Compliance Stories For the Week Ending, August 2, 2025
Data Driven Compliance: Understanding the ECCTA and Its Impact on Fraud Prevention with Vince Walden
Everything Compliance: Episode 158, The No to Corruption in Ukraine Edition
Daily Compliance News: July 31, 2025. The Forgotten Generation Edition
Understanding BBB Ratings: Building Trust and Mitigating Risks — Regulatory Oversight Podcast
Episode 379 -- Update on False Claims Act and Customs Evasion Liability
Data Driven Compliance: Understanding the UK’s New Failure to Prevent Fraud Offense with Sam Tate
Everything Compliance: Episode 157, The Q2 2025 Great Women in Compliance Edition
Daily Compliance News: July 22, 2025, The I-9 Hell Edition
Compliance Tip of the Day: Avoiding CCO Liability
2 Gurus Talk Compliance: Episode 55 – The From Worse to Worser Edition
Daily Compliance News: July 17, 2025, The COSO Yanked Edition
Wire Fraud Litigants Beware: Fourth Circuit Ruling Protects the Banks — The Consumer Finance Podcast
Compliance into the Weeds: Agentic Misalignment and AI Ethics: Analyzing AI Behavior Under Pressure
On August 7, 2025, the United States Department of Justice, Criminal Division, Fraud Section (“DOJ”) issued a declination letter to a U.S.-based insurance company (the “Company”) to resolve alleged violations of the Foreign...more
Introduction: Understanding Fidelity Investigations - Fidelity / Crime / Financial Institution Bonds, in a general sense, cover an insured from the willful theft of property, money, and securities by one of their employees...more
Effective August 1, 2025, Anthem will implement a new claims-editing process that adjusts payments for Medicare Advantage (MA) claims based on an undisclosed, customized chargemaster table. The announcement identifies claims...more
Both the Centers for Medicare & Medicaid Services (CMS) and dozens of the nation’s largest insurance companies have revealed upcoming changes to their prior authorization processes. These changes aim to reduce the prevalence...more
Schnatzmeyer v. State Farm Ins. Co., No. 3:23-CV-02820-K, 2025 WL 1697505, at *1 (N.D. Tex. June 17, 2025). In a case involving two overlapping freeze claims—and a substantial array of legal issues affecting insurers in...more
If you’ve received a settlement check from an insurance company after a car accident, property damage claim, or injury settlement, you might be wondering: how long is an insurance check good for? While holding onto it for a...more
Key Takeaways - First Appellate Interpretation of EKRA: The Ninth Circuit’s decision in United States v. Schena marks the first appellate court interpretation of the Eliminating Kickbacks in Recovery Act (EKRA), affirming...more
Increasing abuses in the claims process have caused insurance companies to rethink the traditional model of sending out cash to pay claims. Far too often, that cash is used for purposes other than fixing damage, with a...more
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
Recently, Pennsylvania Governor Josh Shapiro announced that he launched a new centralized consumer protection hotline, website and email address to assist Pennsylvanians in reporting scams and resolving financial and...more
On December 11, 2024, the U.S. Department of Health & Human Services’ Office of Inspector General (OIG), issued a Special Fraud Alert (Alert) focusing on financial arrangements involving Medicare Advantage (MA) Organizations...more
Attorneys from Ropes & Gray attended the Medicarians Conference from March 31 to April 2, a premier event for Medicare Advantage (MA) and other health insurance brokers, agents, and distribution arms, as well as regional and...more
As a part of our Quarterly Practice Group Update, we are pleased to produce another installment with examples of our continued success in the area of fraud litigation. The New York State Workers’ Compensation Board has...more
On December 23, 2024, various Aetna affiliates (referred to hereafter as Aetna) filed suit against Radiology Partners, Inc., a national, private-equity-backed radiology group, alleging that Radiology Partners defrauded the...more
Surprised insurers are unhappy insurers. And unhappy insurers are more likely to resist paying claims. As are insurers who fail to heed their good faith and other obligations to their policyholders. So if you seek coverage...more
The use of artificial intelligence (AI) technology in the workers’ compensation arena is on the horizon. Given the scale of AI applications and the speed at which the technology is developing and being applied, AI has the...more
In a win for Wiley’s client, a New Jersey appellate court, applying New Jersey law, affirmed a trial court’s decision rescinding four lawyer’s professional liability policies because of material misrepresentations made in the...more
The United States District Court for the Central District of California, applying California law, has held that a lending exclusion in a bankers professional liability policy barred coverage for underlying lawsuits alleging...more
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
These days, artificial intelligence is everywhere we look, and the financial services industry is no different. As AI use increases, regulatory bodies are updating their rules and guidelines detailing how companies should and...more
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
The Mitchell Williams Insurance Regulatory team of attorneys recently attended the National Association of Insurance Commissioners (NAIC) Fall 2024 National Meeting which was held in Denver, Colorado. We have prepared a...more
This month, an interim report on artificial intelligence in the financial sector was published for public comment. The report was written by the Ministries of Justice and Treasury, the Competition Authority, the Securities...more
A class action suit is brewing in Minnesota which has the potential for major implications in the way major case investigations are litigated and negotiated. In Taqueria El Primo LLC et al. v. Illinois Farmers Ins. Co. et...more
Most policyholders are aware of the danger of losses from fraudulent instructions and invoices accomplished through what is known as “social engineering” or related methods. Often this is carried out by an email claiming to...more