Since its launch in 1998, the Medicare Advantage (MA) program has grown rapidly, now enrolling more beneficiaries than traditional Medicare. Unlike traditional Medicare—which generally reimburses providers on a fee-for-service basis (meaning, for the services they perform)—Medicare Advantage operates through a managed care model, with private insurers receiving capitated payments based on the demographics and health […]
With dramatic steps to reshape federal agencies underway, the Department of Health and Human Services (HHS) is now at the center of a contentious overhaul. U.S. Secretary of HHS Robert F. Kennedy Jr. just announced sweeping cuts to HHS, including slashing a quarter of its ~91,000 person workforce and consolidating its 28 divisions into just […]
On April 4, Whistleblower Partners joined over 500 law firms who signed an amicus (friend of the court) brief supporting the suit filed by the law firm Perkins Coie against the Trump Administration. Unfortunately, none of the top 20 law firms in the country (based on annual revenue) signed the brief, often citing the very […]
Fraud against federally funded healthcare programs (such as Medicare or Medicaid) or the Paycheck Protection Programs (PPP) make up the bulk of suits, and recoveries, under the False Claims Act. A newly filed DOJ complaint[1] out of Idaho shows how the two can mix, and demonstrate some potential follow-on FCA effects from criminal healthcare fraud […]
Confirmation hearings for Mehmet Oz, President Trump’s choice to lead the Centers for Medicaid & Medicare Services (CMS), have begun. Since CMS administers the Medicare program, Oz’s stance on the expansion of Medicare Advantage (MA)—a privately-operated alternative to traditional Medicare—could exacerbate existing issues in the American healthcare system and open new doors for healthcare fraud. […]
President Donald Trump has frequently referred to himself as "Tariff Man." So, it’s no surprise that tariffs are at the top of the agenda for his new Administration. Trump has already aggressively imposed tariffs on a broad range of imported goods, including those from China, Canada, and Europe. These tariffs—sometimes sudden and sweeping—have disrupted global […]
Health Net Federal Services (HNFS) and its parent company Centene Corporation have agreed to pay over $11.25 million to resolve False Claims Act allegations related to cybersecurity compliance failures in a Department of Defense contract. The allegations concerned false certifications of compliance with cybersecurity requirements in HNFS’s contract to administer the TRICARE health benefits program […]
Hallie Noecker and Max Voldman wrote an opinion piece for Newsweek maintaining that the Department of Government Efficiency, or DOGE, could have a bigger impact on efficiency if it prioritized using whistleblower information to combat fraud in massive industries like healthcare and defense. The increasingly bold DOGE has been remaking the government at a breakneck […]
Last week, a Phoenix couple pleaded guilty to criminal charges involving healthcare fraud. Unfortunately, this is not remarkable, with approximately 500 annual convictions for healthcare fraud in the U.S. each year over the past five years. What makes this case unique is the staggering size of the fraud. The government alleges that the defendants submitted $1.2 […]
Massachusetts recently enacted a law that might have major impact on investors in the healthcare industry, notable private equity. House Bill 5159 imposes a new rule on those who invest in healthcare companies in the state, requiring disclosure of False Claims Act violations that the companies they invest in may be liable for, or else […]
