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Healthcare Fraud › False Billing › Medical Reimbursement

Troutman Pepper Locke

New York AG Intensifies Investigation and Enforcement Against Alleged Medicaid Fraud

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On June 30, 2025, New York Attorney General (AG) Letitia James announced new lawsuits, criminal charges, and settlements with 25 New York transportation companies related to alleged schemes to defraud Medicaid of millions....more

Pullman & Comley - Connecticut Health Law

Short Staffing May Still be Hindering Health Care in Connecticut but OIG's Exclusion Authority Remains Alive and Well

Pullman & Comley - Connecticut Health Law on

Can a 40-year-old fraud and abuse law that compared to many others is relatively straightforward still get providers into trouble?  Answer: You bet!  In fact, in the first quarter of 2022 alone, the U.S. Attorney for the...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

Proskauer - Health Care Law Brief

False Claims Act Spotlight (3 of 3): Changing Landscape of the FCA in the Courts

Proskauer - Health Care Law Brief on

On August 12, 2021, a panel of the Seventh Circuit voting 2-1 endorsed the existence of an “objective reasonableness” defense under the FCA. United States ex rel. Schutte v. SuperValu, Inc., No. 11-cv-3290, 2021 WL 3560894...more

Bass, Berry & Sims PLC

FCA Medical Necessity Cases May Stand on Firmer Footing After Recent Appellate Decisions

Bass, Berry & Sims PLC on

In recent years, healthcare providers have increasingly faced civil and criminal enforcement actions premised on the allegation that services billed to government healthcare programs were not medically necessary. As a result,...more

Cadwalader, Wickersham & Taft LLP

Health Care Investors Beware: U.S. Attorney Sues Private Equity Firm For Portfolio Company’s Alleged Billing Fraud

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The U.S. Attorney for the Southern District of Florida has recently decided to intervene in a lawsuit brought under the Federal False Claims Act and initiated by a whistleblower. The U.S. Attorney has filed his own...more

Cadwalader, Wickersham & Taft LLP

Trove of SNF Claims Data Released By CMS – Ready for Mining By Auditors and Whistleblowers

Cadwalader, Wickersham & Taft LLP on

Over recent years, the Federal government has trained its sights on potential billing abuses in the Medicare Part A program for Skilled Nursing Facilities (“SNFs”) in the provision of rehabilitation therapy services. The...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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