A lawsuit filed last week by the Department of Justice brings attention to a seldom litigated allegation of fraud against the government: manipulation of a health plan’s Medical Loss Ratio (“MLR”). In general, an MLR is what percentage of premiums a health plan is legally required to spend on patient care, as opposed to money […]
In a recent decision out of the Seventh Circuit, the court upheld a jury verdict that resulted in a $183 million False Claims Act award against Eli Lilly (“Lilly”), the pharmaceutical company. The case, United States ex. rel Streck v. Eli Lilly, was brought by a whistleblower named Ronald Streck, who litigated the case after […]
Medicare, the government-funded insurance program for the elderly and disabled, covers certain wound care products known as skin substitutes, basically artificial skin that’s used to replace damaged or missing skin. A new report by the Office of Inspector General draws attention to skyrocketing costs and potential fraud in the industry. In just two years, Medicare […]
The Department of Justice is generally relatively transparent about its fraud prevention and False Claims Act enforcement priorities. They generally focus on broad issues that affect the lives of millions upon millions of Americans, such as the Medicare Advantage program (which covers over half of Medicare beneficiaries), unsafe medical devices, and kickbacks in healthcare. But […]
The COVID-19 pandemic threw the US into intense economic turmoil. Businesses were closed for public health on a scale never seen before- to keep the economy from collapse, the federal government successfully deployed trillions of dollars of stimulus. The lion’s share of economic stimulus came through the Paycheck Protection Program (“PPP”), which injected nearly a […]
A recent report from Bloomberg shows that, since January 2025, the SEC has continued to file enforcement actions at roughly the same pace as it did during the same period last year. Forty-four enforcement actions were filed between President Trump’s inauguration and the end of June. During the same time period in 2024, the SEC […]
DOJ just won another victory in the long-running Omnicare case. Back in April, the jury found that Omnicare had submitted 3.3 million false claims and was liable for damages of over $135 million. The Judge trebled that damages number, as required by the False Claims Act, reaching a final damages amount of over $406 million, […]
Genetic testing fraud enforcement has dramatically increased in recent years, and that trend continues this week with yet another suit. Recurring schemes in this space include billing Medicare for a test or screening that was 1. not medically necessary, 2. not ordered by the treating physician, and/or 3. tainted by a kickback. Medicare will cover […]
Today, the Department of Justice announced a new Antitrust Whistleblower program for antitrust violations that include actions affecting the Postal Service. Years in the making, this Program fills a significant gap in existing whistleblower programs by providing a means for individuals to report price-fixing, bid-rigging, and other antitrust conspiracies. Antitrust violations harm consumers and the […]
CVS, the largest pharmacy chain in the USA, has been accused of fraud against the Medicaid Programs of nearly 30 States. The allegations stem from a set of laws known as the “Usual and Customary” (“U&C”) requirements. U&C laws generally require pharmacies to disclose how much various customers are paying for drugs. The goal of […]
