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 […]
In January 2025, Hino Motors Ltd., a subsidiary of Toyota Motor Corporation, agreed to a comprehensive settlement exceeding $1.6 billion with U.S. authorities to resolve allegations of emissions fraud. This resolution addresses both criminal charges and civil claims related to the company's misconduct in falsifying engine emission and fuel consumption data. Of interest to whistleblowers […]
The Department of Justice (DOJ) last week reported nearly $3 billion in recoveries under the False Claims Act (FCA) for fiscal year 2024. These successful FCA cases targeted fraud in healthcare, defense contracting, pandemic relief, and cybersecurity, among other areas. A significant portion, $1.67 billion, came from healthcare fraud cases, including improper billing practices and […]
Last week, the Department of Justice (DOJ) announced a $15.875 million settlement with Booz Allen Hamilton over alleged False Claims Act (FCA) violations involving a scheme to rig Department of Defense (DoD) bids using insider information. The alleged fraud centered on a Booz Allen subsidiary, Booz Allen Hamilton Engineering Services (BES), which supplied military training […]
