DOJ Sues California Medicaid Plan Over $320M Misused Federal Funds
The DOJ sues Inland Empire Health Plan for allegedly misusing $320 million in federal Medicaid surplus funds, highlighting compliance challenges in managed care programs.
Health First Urgent Care Settles $2.8M Medicare Medicaid Overbilling Case
Health First Urgent Care agrees to $2.8 million settlement for Medicare and Medicaid overbilling linked to improper diagnostic test billing practices in Washington State.
Court Awards Attorney Fees to FCA Defendants Due to Relator's Fraudulent Conduct
A Massachusetts court awarded attorneys' fees to FCA defendants after finding relator engaged in fraudulent conduct by ordering unnecessary PCR tests to support whistleblower claims under the False Claims Act.
Skilled Nursing Improper Payments Double Medicare Average; Compliance Vital
2024 report shows skilled nursing improper payments at 17.2%, double Medicare average. Strong compliance and thorough documentation crucial to avoid audits and fraud allegations.
Eye Consultants of Pennsylvania Settles for $790K Over Medicare Billing Violations
Eye Consultants of Pennsylvania agrees to $790,000 settlement over False Claims Act violations involving Medicare E&M billing irregularities. Federal enforcement underscores commitment to Medicare compliance.
DOJ-HHS Relaunches False Claims Act Working Group to Intensify Healthcare Fraud Enforcement
The DOJ and HHS have reestablished the False Claims Act Working Group to heighten enforcement of healthcare fraud, focusing on Medicare, Medicaid, pricing, and EHR compliance risks.
DOJ and HHS Form Working Group to Enhance False Claims Act Enforcement in Healthcare
The DOJ and HHS have established a joint False Claims Act Working Group to strengthen healthcare fraud investigations using advanced data analytics and interagency cooperation.
DOJ and HHS Launch Joint Working Group to Boost False Claims Act Enforcement in Healthcare
In July 2025, DOJ and HHS formed a joint Working Group to intensify False Claims Act enforcement, focusing on data-driven investigations and payment suspensions in healthcare fraud cases.
DOJ and HHS Relaunch False Claims Act Working Group to Target Healthcare Fraud
The DOJ and HHS reestablish the False Claims Act Working Group to enhance enforcement against healthcare fraud and abuse in federal programs, emphasizing compliance and whistleblower roles.
Enforcement and Broker Compliance in Medicare Advantage: Key Insights
Detailed analysis of recent Medicare Advantage enforcement activities focused on broker arrangements, Oak Street settlement, and DOJ False Claims Act litigation impacting healthcare compliance and beneficiary protection.