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.
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.
DOJ Investigates UnitedHealth Group Over Medicare Advantage Billing Practices
The DOJ is investigating UnitedHealth Group for Medicare Advantage billing practices amid nationwide scrutiny on upcoding, prompting CMS to increase audits of plans and intensify fraud prevention efforts.
Operation Gold Rush Uncovers $10.6B Medicare Fraud Scheme Leveraging AI for Prevention
Operation Gold Rush exposes a $10.6 billion Medicare fraud scheme involving international crime rings and highlights the shift towards AI-driven proactive fraud prevention and enhanced Medicare data analytics.
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.