False Claims Act

On May 27, in furtherance of the March 16, 2026 Executive Order on Eliminating Fraud, Assistant Attorney General Brett A. Shumate issued a memo titled “Accelerating Review and Enhancing Enforcement in Benefits Fraud Matters.” The Memo announced new measures by the U.S. Department of Justice (DOJ) to strengthen False Claims Act (FCA) enforcement…

The U.S. Department of Justice (DOJ) recently announced a new initiative to enhance its working relationship with data miners who bring cases as whistleblowers under the False Claims Act (FCA). The initiative is dubbed “FOCUS,” an acronym for Fraud Oversight through Careful Use of Statistics. 

There has been a sharp increase in qui tam complaints…

On March 11, the U.S. Department of Justice and U.S. Attorney’s Office announced that Aetna, a national health insurer, has agreed to pay $117,700,000 to settle alleged violations of the False Claims Act (FCA). The government was investigating Aetna for submitting inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan beneficiaries, which increased Aetna’s…

The U.S. Department of Justice recently announced a settlement with Patients Choice Laboratories (“PCL”), a diagnostic laboratory headquartered in Indianapolis, Indiana, under which PCL will pay over $9.6 million to resolve allegations that it violated the federal False Claims Act (FCA) and Anti-Kickback Statute (AKS). The government alleged that the lab knowingly submitted claims to…

The New York Office of the Medicaid Inspector General (OMIG) publishes audit protocols to “assist the Medicaid provider community in developing programs to evaluate compliance with Medicaid requirements under federal and state statutory and regulatory law.”1 Such protocols are “applied to a specific provider type or category of service in the course of an…

An article in the August issue of Healthcare Risk Management, “DOJ Targeting Healthcare for False Claims Act Enforcement,” discussed recent enforcement activity by the U.S. Department of Justice (DOJ) under the False Claims Act (FCA). Rivkin Radler’s Jeff Kaiser was quoted in the article.

Jeff predicted that the FCA will continue to…

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 and individual defendants in the case moved to bar the testimony of a medical billing expert whose report was riddled with AI-generated errors…

On July 2, the U.S. Department of Justice (DOJ) and Department of Health and Human Services (HHS) announced the formation of the DOJ-HHS False Claims Act Working Group to strengthen “their ongoing collaboration to advance priority enforcement areas” in combating healthcare fraud. The two agencies cited the long history of partnership between them in enforcing…

On May 1, a whistleblower filed a complaint under the federal False Claims Act (FCA) against Aetna, Elevance Health (formerly Anthem) and Humana alleging that the insurers paid hundreds of millions of dollars in illegal kickbacks to induce brokers including GoHealth, eHealth and SelectQuote (the “Brokers”) to steer beneficiaries to their Medicare Advantage plans. While…