In November 2025, the Department of Justice announced a $45 million settlement with Vohra Wound Physicians Management, LLC, and its founder, Dr. Ameet Vohra. Vohra operated one of the largest wound care services in the country, treating patients in nursing homes and skilled nursing facilities nationwide. The government alleged that Vohra ran a systematic scheme to defraud Medicare by programming its own electronic health record and billing software to ensure that Medicare was always billed … [Read more...]
Lab Test Fraud: Unnecessary or Fabricated Diagnostic Tests Billed to Medicare
In January 2026, the Department of Justice announced that Clinical Laboratory LTD Holding LLC, formerly known as Labtech Diagnostics LLC, and its founder and CEO, Joseph Labash, agreed to pay at least $6.8 million to resolve False Claims Act allegations involving illegal kickbacks to physicians. The settlement brought total civil recoveries related to Labtech to more than $11.5 million, including amounts recovered separately from nine doctors whose referral relationships with the lab were also … [Read more...]
Home Health Fraud: The Billing Schemes That Cost Medicare Billions Each Year
In 2024, Intrepid U.S.A., Inc., a nationwide home health and hospice provider headquartered in Dallas, Texas, agreed to pay $3.85 million to resolve False Claims Act allegations affecting both its home health and hospice lines of business. The government alleged that between 2016 and 2021, 19 Intrepid home health facilities submitted claims to Medicare for services provided to patients who did not qualify for the Medicare home health benefit, where the services were not reasonable or medically … [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...]
Report Says Medicare Part C Insurers Are Pocketing Billions Through Risk Adjustment Schemes
Medicare Advantage, or Part C, was created with the idea that private insurers could provide more cost-effective healthcare than traditional Medicare. But while the program has become popular — it’s the largest taxpayer-funded health insurance program in the United States with a $450 billion annual budget and more than 31 million participants — it is losing billions to fraud. As recent False Claims Act settlements and a recent report in the Wall Street Journal show, one of the costliest … [Read more...]