On January 16, the U.S. Department of Justice (DOJ) released its annual report on civil fraud recoveries (settlements and judgments) for FY2025, along with a press release highlighting DOJ’s civil enforcement efforts.
Continue Reading DOJ Releases Record-Setting Civil Fraud Recovery Statistics and Results…Our Annual Look Behind the NumbersKaiser Permanente Affiliates Settle Medicare Risk Adjustment Fraud Case for $556 Million
By Emily Farmer, Lindsey Fetzer, Brian Roark & Julia Tamulis on
On January 14, the Department of Justice (DOJ) announced that five Kaiser Permanente affiliates agreed to pay $556 million to resolve allegations that they violated the False Claims Act (FCA) by submitting unsupported diagnosis codes for Medicare Advantage (MA) beneficiaries to increase reimbursement from the federal government. The relators will receive approximately $95 million as their share of the recovery.
Continue Reading Kaiser Permanente Affiliates Settle Medicare Risk Adjustment Fraud Case for $556 MillionHHS-OIG’s Latest Wound Care Report Warrants Careful Scrutiny
On September 9, the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) released a major report (Report) regarding the fraud risks currently associated with skin substitute products billed to Medicare.
Continue Reading HHS-OIG’s Latest Wound Care Report Warrants Careful ScrutinyCracking Down on Customs Fraud: How the False Claims Act Raises the Stakes for Importers
By Denise Barnes on
The federal government’s growing use of the False Claims Act (FCA) to pursue customs fraud signals a new era of trade enforcement, with importers facing heightened scrutiny and increased risk of whistleblower actions.
Continue Reading Cracking Down on Customs Fraud: How the False Claims Act Raises the Stakes for ImportersRare (c)(2)(A) Dismissal of Long-Running FCA Case
By Matt Curley & Scott Gallisdorfer on
Posted in FCA Alert
We were quoted in a Law360 article summarizing a September 2025 decision by a Utah federal court to dismiss False Claims Act (FCA) allegations against our clients.
Continue Reading Rare (c)(2)(A) Dismissal of Long-Running FCA CaseFalse Claims Act Settlements to Know from the First Half of 2025
With the first half of 2025 in the rearview mirror, the government’s continued focus on False Claims Act (FCA) enforcement shows no signs of slowing. In fact, the Department of Justice recently announced the results of a record-setting National Health Care Fraud Takedown, which resulted in criminal charges against 324 defendants for alleged healthcare fraud schemes involving over $14.6 billion.
Continue Reading False Claims Act Settlements to Know from the First Half of 2025Ninth Circuit Ruling Outlining Kickback Limits Under EKRA
By Danielle Sloane on
I commented on a recent Ninth Circuit ruling clarifying a 2018 law that prohibits kickbacks for referring patients to medical testing labs and addiction treatment centers under the Eliminating Kickbacks in Recovery Act (EKRA).
Continue Reading Ninth Circuit Ruling Outlining Kickback Limits Under EKRAExploring the DOJ’s Use of AI in Healthcare Fraud Enforcement
By Matt Curley on
Posted in Enforcement, FCA Deep Dive
TIn one of its largest coordinated enforcement efforts to date, the Department of Justice recently announced charges against more than 300 defendants in connection with alleged healthcare fraud schemes.
Continue Reading Exploring the DOJ’s Use of AI in Healthcare Fraud EnforcementWound Care in the Crosshairs: Reimbursements Risks Amid Skin Substitute Fraud Investigations
By Kristin Bohl, Denise Barnes & Garrah Carter-Mason on
Effective wound care is critical for patients recovering from surgery or managing chronic or non-healing wounds. Advances in treatment have led to the development of skin substitutes—bioengineered or natural materials designed to promote healing by replacing or supporting damaged skin. While these innovations hold great promise for the future of wound care, they have also come under increased scrutiny by regulatory agencies and the Department of Justice (DOJ).
Continue Reading Wound Care in the Crosshairs: Reimbursements Risks Amid Skin Substitute Fraud InvestigationsHealthcare Fraud Enforcement Trends from 2024 and Projected Issues for 2025
By Taylor Sample on
I recently authored an article for the American Bar Association (ABA) Health Law Section regarding healthcare fraud enforcement trends in 2024 and the projected issues for 2025, which highlights the Department of Justice’s (DOJ) increasing focus on fraud, waste, and abuse.
Continue Reading Healthcare Fraud Enforcement Trends from 2024 and Projected Issues for 2025