Data-mining whistleblowers are no longer a sideshow. They’re rapidly becoming a dominant force in False Claims Act filings. And the Department of Justice has a message: sophisticated analytics are welcome, but speculative pattern-detecting is not. Traditionally, whistleblowers are insiders, generally employees who spot misconduct at work and come forward. Data miners flip that model, using […]
Each year, CMS, the agency that operates Medicaid and Medicare releases an Improper Payment Report, which uses statistics, data analyses, and information learned from government enforcement actions, to estimate the amounts of payments that do not meet CMS program requirement. These include estimated money lost to fraud, but also to negligence, mistake, or other more […]
Fraud against the Medicare Advantage (MA) program, a privately-run alternative to traditional Medicare, has been in the news a lot recently. In January, Kaiser Permanente agreed to pay over $500 million to resolve allegations that it was defrauding the program, in a whistleblower case partially launched by our client, James Taylor. In February, HHS-OIG released […]
Early this month, CVS agreed to pay nearly $38M to settle five related whistleblower cases concerning its dispensing of insulin pens. The government and many whistleblowers alleged that CVS improperly requested and received reimbursement for premature refills, dispensed more insulin pens than patients needed according to their prescriptions, and falsely under-reported the days-of-supply of insulin […]
In early April 2025, the Department of Justice filed a lawsuit against one of the nation’s largest wound care providers, Vohra, and its majority owner. Vohra contracts with hundreds of nursing homes and other long-term care providers to come in and provide wound care for patients in those facilities. This case is the latest datapoint […]
Last week, Rite Aid, America’s third largest retail pharmacy after CVS and Walgreens, settled two massive whistleblower cases, agreeing to pay potentially upwards of $500 million to resolve disparate allegations of healthcare fraud. The Opioid Dispensing Settlement: Last Wednesday, the Department of Justice announce that Rite Aid will pay up to roughly $410 million to […]
A recent Federal court decision coming out of New Jersey demonstrates the viability of an unusual kind of whistleblower, a privately defrauded party. The most common protype of a whistleblower under the False Claims Act (FCA) is a corporate insider who sees fraud against the government at their employer or a company they work with […]
The federal government spends roughly $6 trillion annually. A huge amount of that money goes into certain, predictable categories year after year. Spending on Medicare and Medicaid account for roughly 25% of the federal budget, defense spending, in recent years accounts for another 15% or so. Social Security payments and interest account for another 33% […]
Artificial intelligence (AI) is seemingly everywhere these days. It’s upending industries, driving record stock market returns, and, like all revolutionary technologies, generally disrupting our current world as it pushes us towards something new. Its power is both awesome and ever changing. Can AI one day become a whistleblower? Under the False Claims Act, whistleblowers can […]
The Paycheck Protection Program (PPP) was a tremendously successful COVID relief program. It distributed nearly a trillion dollars in loans to businesses to keep employees on the payroll and stabilize the U.S. economy during the tumult of early 2020. The PPP helped the U.S. usher in one of the strongest economic recoveries in the world. […]
