On June 30, 2025, the Department of Justice announced the results of its 2025 National Health Care Fraud Takedown, the largest in the program's history. The DOJ charged 324 defendants in connection with fraud schemes totaling more than $14.6 billion in intended losses to federal healthcare programs. Among the cases was a coordinated set of charges against transnational criminal organizations operating out of Russia and Eastern Europe that had used U.S.-based shell companies to submit … [Read more...]
Trump Administration Trade Policies: New Opportunities for Customs Fraud Whistleblowers
On December 18, 2025, the Department of Justice announced a $54.4 million settlement with Ceratizit USA LLC, a distributor of tungsten carbide products, to resolve allegations that the company evaded customs duties on goods imported from China. The settlement is the largest customs fraud resolution in False Claims Act history. The whistleblower who brought the case to the government's attention received a share of the recovery under the law. The Ceratizit case did not arise in isolation. It … [Read more...]
AI and Healthcare Fraud: How Artificial Intelligence Is Being Used to Defraud Medicare
On January 14, 2026, the Department of Justice announced that five Kaiser Permanente affiliates had agreed to pay $556 million to resolve False Claims Act allegations that they submitted unsupported diagnosis codes for Medicare Advantage enrollees to inflate reimbursements from the federal government. The settlement is the largest False Claims Act resolution involving Medicare Advantage risk adjustment fraud in history. Whistleblowers who brought the case received a share of the recovery. The … [Read more...]
Sutter Health Medicare Advantage Fraud Case Shows the Power of Whistleblowers
Sutter Health Medicare Advantage Fraud Case Shows the Power of Whistleblowers In August 2021, Sutter Health and several affiliated medical foundations agreed to pay $90 million to settle allegations that they submitted inaccurate diagnosis data to inflate payments under the Medicare Advantage program. The case is one of the largest Medicare Advantage fraud settlements on record, and it began with a single whistleblower, a former employee of the Palo Alto Medical Foundation who recognized what … [Read more...]
Pharmaceutical Fraud: Off Label Marketing, Kickbacks, and False Claims Act Liability
Pharmaceutical Fraud: Off Label Marketing, Kickbacks, and False Claims Act Liability Pharmaceutical companies have produced some of the largest False Claims Act settlements in history, and enforcement in this area continues at a significant pace. The conduct at the center of these cases follows patterns that have repeated across the industry for decades: drugs promoted for uses the FDA has not approved, kickback payments disguised as speaker fees or consulting arrangements, and prescriptions … [Read more...]
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