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Health Insurance › False Claims Act (FCA) › False Billing

Goodwin

Aetna’s “Fraud Scheme” Lawsuit Against Radiology Group Highlights Health Plans’ Resistance to Private-Equity-Backed Providers

Goodwin on

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

Farrell Fritz, P.C.

Supreme Court To Decide Standard For Government Dismissal Of False Claims Act Cases

Farrell Fritz, P.C. on

The Supreme Court granted certiorari in a case that will decide two important questions under the False Claims Act (FCA).  In United States ex rel. Polansky v. Executive Health Resources, Inc., the Relator asks the Court to...more

Polsinelli

As DOJ Focuses on Medicare Advantage Reimbursement, So Should Health Care Providers

Polsinelli on

Over the past year, the federal government has taken concrete steps to fulfill its promise of a heightened commitment to investigating and enforcing health care fraud within the Medicare Advantage program (Medicare Part C). ...more

Vinson & Elkins LLP

DOJ Intervenes in Another Medicare Advantage FCA Suit

Vinson & Elkins LLP on

On September 13, 2021, the Department of Justice (“DOJ”) intervened in a False Claims Act (“FCA”) suit alleging that a health insurer defrauded the government by submitting false patient data to wrongfully inflate payments...more

Morgan Lewis - Health Law Scan

$1 Million Settlement Reached in AseraCare FCA Case

Morgan Lewis - Health Law Scan on

In an action especially significant to hospice providers but also other healthcare providers regarding the determinations of medical necessity for Medicare billing purposes, the US Department of Justice (DOJ) and AseraCare...more

The Volkov Law Group

Double Whammy for United Healthcare: Two False Claims Act Cases in Two Weeks

The Volkov Law Group on

The False Claims Act is the government’s weapon of choice in fighting healthcare fraud. In the beginning of the Obama Administration, Congress amended the False Claims Act and enacted a wish list from DOJ prosecutors. ...more

BakerHostetler

Insurer Actions Cut the Heart Out of Out-of-Network Providers

BakerHostetler on

Aetna Life Insurance Company recently won a $37 million verdict against a group of Northern California surgical centers, Bay Area Surgical Management, LLC and its affiliates (collectively, Bay Area), for an alleged...more

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