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Fraud › Reimbursements › Insurance Industry

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

Anthem's New Chargemaster-Based Claim Edits: Which Charges and Providers Will Anthem's New Process Target and How Will It Impact...

Davis Wright Tremaine LLP on

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

Pietragallo Gordon Alfano Bosick & Raspanti,...

The Medicare Advantage Program: Public Money & Private Insurance Companies

Pietragallo Gordon Alfano Bosick & Raspanti,... on

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

Morrison & Foerster LLP - Class Dismissed

One ESTOPP Shop: The Ninth Circuit Weighs In On The Use Of Equitable Estoppel To Compel Arbitration In Two Recent Decisions

Morrison & Foerster LLP - Class Dismissed on

When can you compel arbitration of a putative class action? The law is developing quickly and still doesn’t provide a crystal clear answer. The Ninth Circuit recently weighed in on two cases examining what happens when the...more

Faegre Drinker Biddle & Reath LLP

A Cautionary Tale and a Wistful Remembrance About Settlement Security

Faegre Drinker Biddle & Reath LLP on

Our language around settlements connotes war and peace – in settling we are “buying our peace” or “ceasing hostilities.” The old saw is that a good settlement leaves no one satisfied, but in truth, a good settlement leaves...more

Buchalter

From Frying Pan to Fire: Strategic Issues When Reimbursement Disputes Turn Into Criminal Investigations

Buchalter on

Early on the morning of June 13, 2017, over one hundred federal agents raided facilities across southern California belonging to behavioral health provider Sovereign Heath. The agents provided search warrants indicating that...more

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