Hospital Billing Fraud: Common Red Flags for Whistleblowers Hospitals and health systems are among the most frequent targets of False Claims Act enforcement. The Department of Justice recovered over $5.7 billion in healthcare fraud settlements in fiscal year 2025 alone, the highest total ever recorded. A significant portion of that recovery came from cases involving hospitals, and many of those cases began with someone on the inside who noticed something wrong and came forward. If you work … [Read more...]
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Procurement Fraud Whistleblowers May Have Two Paths to Recovery The Department of Justice is sending a clear message to the market: if you have knowledge of anticompetitive conduct affecting federal procurement, the government wants to hear from you. A recent keynote address by Acting Deputy Assistant Attorney General Daniel Glad made plain that criminal antitrust enforcement is accelerating and that whistleblowers are now central to that effort. For individuals with knowledge of bid … [Read more...]
Why Whistleblowers Should Not Use AI to Draft Case Summaries
Why Whistleblowers Should Not Use AI to Draft Case Summaries If you believe your employer has been defrauding the federal government, your first instinct may be to organize your thoughts before contacting an attorney. Increasingly, potential clients are turning to AI tools like ChatGPT to help draft case summaries or intake narratives before reaching out to a law firm. While that impulse is understandable, using AI to build your case summary can create serious legal risks that may compromise … [Read more...]
CMS Proposed Rule Targets Medicare Advantage Risk Adjustment Fraud
CMS Proposed Rule Targets Medicare Advantage Risk Adjustment Fraud The Centers for Medicare & Medicaid Services recently announced a proposed rule that would restrict a widespread billing practice used by Medicare Advantage plans to inflate payments from the federal government. The proposal signals that the government is committed to combating risk adjustment fraud, an area with substantial and growing False Claims Act exposure. What CMS proposed On January 26, 2026, CMS released … [Read more...]
California SB 351, Private Equity in Healthcare, and False Claims Act Risk
California SB 351, Private Equity in Healthcare, and False Claims Act Risk On October 6, 2025, California Governor Gavin Newsom signed Senate Bill 351 into law, codifying and expanding California’s longstanding prohibition on the corporate practice of medicine. The law took effect on January 1, 2026, and directly targets private equity groups and hedge funds involved in physician and dental practices. SB 351 establishes clear limits on how investors can influence clinical decision making, … [Read more...]
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