AI and the False Claims Act
False Claims Act Insights - Bitter Pills: DOJ Targets Pharmacies for FCA Enforcement
Hospice Insights Podcast - Election Inspection: Be Proactive to Avoid Costly Election Statement Denials
The Trend of Threatening Physicians for Personal Gain
Daily Compliance News: June 17, 2025, The JBS Goes Public Edition
False Claims Act Insights - Will Recent Leadership Changes Lead to FCA Enforcement Policy Changes?
Daily Compliance News: June 16, 2025, The Golden Share Edition
Hospice Insights Podcast - Still Number One: Healthcare Fraud Remains Central in DOJ’s White Collar Enforcement Plan
False Claims Act Insights - How Payment Suspensions Can Impact FCA Litigation
Daily Compliance News: May 16, 2025, The Ethics Nightmare Edition
False Claims Act Insights - Trump DOJ Sharpens Its Focus on Healthcare Fraud
How Life Sciences Companies Can Create a Culture of Compliance When Expanding to the U.S. Market
False Claims Act Insights - DOJ’s Reliance on FCA to Pursue Covid-Related Fraud
UPIC Audits
Criminal Health Care Fraud Enforcement: Projections for 2025 and Beyond – Diagnosing Health Care Video Podcast
AGG Talks: Home Health & Hospice Podcast - Episode 10: Anti-Kickback Compliance for Hospice and Skilled Nursing Providers
False Claims Act Insights - Stranger Than Fiction? An FCA April Fools’ Day Episode
The Presumption of Innocence Podcast: Episode 53 - Diagnosis: Innocent – A Doctor’s Journey to Acquittal
False Claims Act Insights - Reality Checks: How to Approach Healthcare Transactions Without Triggering FCA Liability
Enhancing Compliance: The Power of Independent Monitorships in Consumer Protection — Regulatory Oversight Podcast
The epidemic of out-of-control generative artificial intelligence in litigation filings has metastasized to a False Claims Act (FCA) lawsuit against a group of Utah anesthesiologists. On July 25, Mountain West Anesthesia, LLC...more
There’s always a “but” when it comes to AI. It has great potential, but there’s always the risk of bad things happening. In the case of the False Claims Act and healthcare, that’s very much the case. In a recent article for...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
CMS announced the rollout of the WISeR (Wasteful and Inappropriate Service Reduction) model in June. It aims to use technologies like artificial intelligence (AI) to “ensure timely and appropriate Medicare payment for select...more
On June 30, 2025, the U.S. Department of Justice (“DOJ”), together with the U.S. Department of Health and Human Services Office of Inspector General (“HHS OIG”) and other law enforcement partners, announced the results of the...more
The Department of Health and Human Services and the Department of Justice have formed a False Claims Act (FCA) enforcement working group to target health care fraud. Our Health Care Litigation Group highlights what industry...more
A large health system implements an Artificial Intelligence (AI)-powered clinical decision support tool that promises to ensure “complete and accurate” diagnosis documentation. Within six months, the system’s Medicare...more
Welcome to our seventh issue of 2025 of The Health Record -- our healthcare law insights e-newsletter. In this edition, we look at the so called “One, Big, Beautiful Bill Act” and its impacts on Medicaid and healthcare, the...more
On June 30, the Department of Justice (DOJ) announced the largest coordinated health care fraud enforcement effort in U.S. history, involving criminal charges against over 300 defendants and over $14.6 billion in health care...more
On June 27, 2025, the Centers for Medicare & Medicaid Services (“CMS”), through its Innovation Center (“CMMI”), released the Request for Applications (“RFA”) for a new payment and service delivery initiative: the Wasteful and...more
The pharmaceutical industry faces escalating risks from sophisticated fraud schemes, including counterfeit drug distribution, billing irregularities, and corporate malfeasance. Forensic analytics—powered by AI and advanced...more
The Administrator for the Centers for Medicare & Medicaid Services (CMS), Dr. Mehmet Oz, spoke to non-profit health system executives, investors, and industry observers this week at the 25th Annual Not-for-Profit Healthcare...more
Ambulatory surgery centers (ASCs) have become a large and growing part of the health care industry. ASCs offer same-day surgical care, including diagnostic and preventive procedures, and their popularity has recently grown....more
As the saying goes, the more things change, the more they stay the same – and the world of health care fraud enforcement is no exception. Recent years have seen a wave of novel technologies, emerging threats to our nation’s...more
Join the industry’s top litigators and leading plan counsel at ACI’s 16th Annual Advanced Forum on Managed Care Disputes and Litigation, for two days of discussions designed to address emerging areas of concern for MCOs in...more
Here are curated AG and federal regulatory news stories highlighting key areas in which state and federal regulators’ decisions are having an impact across the US: •AGs and DOJ Submit Revised Final Judgment in Google...more
ERISA Health Plan clients are engaged in nearly every industry in the United States. There are nearly 139 million Americans covered by ERISA Health Plans and 2.5 million Health Plans. Yet, operating a health plan has become...more
On January 29, the New York State Office of the Medicaid Inspector General (OMIG) published its 2025 Work Plan, which provides a preview of the OMIG’s program integrity initiatives for the upcoming year. While this post...more
Morrison Foerster partner Carrie H. Cohen, global co-chair of the Investigations + White Collar Defense Group and State + Local Government Enforcement team, spoke with Christine Wong, a partner in MoFo’s Investigations +...more
Key Points - - It remains to be seen what priorities Robert F. Kennedy Jr. and Marty Makary might set if confirmed as HHS secretary and FDA commissioner, respectively. - The Trump administration will likely focus on drug...more
In 2025, whistleblower regulations are poised for major evolution, reflecting a renewed commitment to transparency and accountability. The Ethics and Compliance Initiative (ECI) 2023 survey revealed a startling statistic:...more
Looking for compliance education and networking in your area? HCCA’s Regional Healthcare Compliance Conferences offer practitioners convenient, local compliance education on a wide variety of current and emerging topics...more
Background on Indiana’s “Baby HSR” Law - Indiana passed Senate Bill 9 in March 2024, which requires an Indiana healthcare entity involved in a merger or acquisition with another healthcare entity with a value of at least...more
The National Football League must pay more than $4.7 billion in class-action damages for overcharging subscribers of its “Sunday Ticket” telecasts, a California federal jury said on Thursday....more
In February 2024, the Department of Justice (“DOJ”) announced the results of its 2023 False Claims Act (“FCA”) enforcement efforts. Through those efforts, it obtained more than $2.6 billion in overall recoveries, and of that...more