News & Analysis as of

Fraud › Medicare Advantage › Health Care Providers

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

Three key takeaways from the CMS Innovation Center’s new WISeR Model

McDermott+ on

The last week of June was a busy one when it comes to news about prior authorization – a major tool used by health plans and the federal government to manage healthcare utilization. The week started with a commitment from...more

Foley & Lardner LLP

Unpacking the Federal Anti-Kickback Statute’s Application to Payments to Medicare Advantage Agents and Brokers

Foley & Lardner LLP on

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

Polsinelli

The OIG’s Concerns with Potentially Fraudulent Medicare Advantage Marketing

Polsinelli on

The HHS Office of Inspector General (“OIG”) released a Special Fraud Alert to inform health care professionals (“providers”) and Medicare Advantage Organizations (“MAOs”) about the OIG’s view of potentially abusive marketing...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

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

Sheppard Mullin Richter & Hampton LLP

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

Sheppard Mullin Richter & Hampton LLP on

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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