A 2024 Department of Justice announcement revealed that Medisca Inc., a pharmaceutical ingredient supplier, agreed to pay $21.75 million to resolve False Claims Act allegations. The DOJ alleged that Medisca's pricing scheme caused pharmacies that purchased its ingredients to submit inflated prescription claims to the Defense Health Agency, allowing them to fraudulently bill federal healthcare programs, often thousands of dollars per prescription. The case was initiated by a pharmacist who … [Read more...]
Hospice Fraud: When Patients Who Aren’t Dying Are Billed as Terminal
In recent years, Gentiva Health Services, the successor to Kindred at Home, one of the country's largest hospice providers, agreed to pay $19.428 million to resolve allegations spanning multiple states and a decade of alleged misconduct. The settlement resolved allegations that, from 2010 until February 2020, Kindred and related entities knowingly submitted false claims for hospice services provided to patients who were not terminally ill and then concealed or avoided their obligation to repay … [Read more...]
When the Management Company Is the Problem: MSO Fraud and False Claims Act Liability
On September 8, 2025, the Department of Justice announced that the former chief executive officer of True Health Diagnostics, LLC, a clinical laboratory based in Frisco, Texas, agreed to pay $4.25 million to resolve allegations that he orchestrated a kickback scheme funneled through management services organizations. Two physicians and seven marketers agreed to pay an additional $1.82 million. With those settlements, the DOJ's total civil False Claims Act recoveries for kickbacks to healthcare … [Read more...]
Post-COVID Healthcare Billing: Ongoing Fraud Schemes Whistleblowers Should Know
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...]
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...]
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