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.
Kaiser Permanente Settles for $556 Million in Medicare Advantage Overbilling Case
Kaiser Permanente agrees to a $556 million settlement over Medicare Advantage overbilling accusations. Learn about the implications for the insurance industry.
Florida Medical Supply Fraud Highlights Serious Insurance Compliance Issues
Evelyn Herrera's fraudulent billing scheme raises critical insurance compliance issues. Discover insights on healthcare fraud and regulatory enforcement actions.
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.
Trump Administration Proposes Medicare Pilot for GLP-1 Weight Loss Drug Coverage
Trump administration proposes a Medicare and Medicaid pilot to cover GLP-1 weight loss drugs, highlighting access benefits alongside fraud and regulatory oversight challenges.
Massachusetts Man Pleads Guilty in $4M Medicare DME Fraud Scheme
Krishna Gidwani pleaded guilty to conspiracy in a $4M Medicare fraud involving durable medical equipment. Part of DOJ's 2025 National Health Care Fraud Takedown.
DOJ Expands Probe into UnitedHealth’s Medicare Billing Practices
The DOJ is investigating UnitedHealth Group's Medicare billing practices, focusing on diagnostic coding and in-home evaluations that may have led to inflated government payments. This probe highlights compliance and regulatory risks in Medicare Advantage programs.
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.