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...]
DOJ Makes First Antitrust Whistleblower Award in EBLOCK Case
DOJ Makes First Antitrust Whistleblower Award in EBLOCK Case On January 29, 2026, the Department of Justice’s Antitrust Division announced its first ever award of $1 million under the Antitrust Whistleblower Program. The whistleblower in this case provided information that led to criminal antitrust and fraud charges through a deferred prosecution agreement against EBLOCK Corporation, an online auction platform for used vehicles. As part of the settlement, EBLOCK agreed to pay a $3.28 million … [Read more...]
DOJ Reports Record $6.8 Billion in False Claims Act Recoveries for FY 2025
The Department of Justice (DOJ) announced record recoveries under the False Claims Act in 2025, with reported settlements and judgments totaling over $6.8 billion. This represents the highest single-year recovery figure in the statute’s history. However, the figures in DOJ’s press release require additional context. Understanding the FY 2025 Recovery Figures On January 15, 2026, DOJ released its annual False Claims Act statistics for fiscal year (FY) 2025. DOJ reported $6.8 billion … [Read more...]
ABA Therapy Fraud and the False Claims Act
ABA Therapy Fraud and the False Claims Act Applied Behavior Analysis (ABA) therapy is a widely used treatment for children diagnosed with autism spectrum disorder, with Medicaid and private insurers spending billions each year on these services. While ABA therapy can provide legitimate benefits when properly administered, recent federal audits have identified widespread billing irregularities and compliance failures in the ABA therapy industry. These findings raise serious questions about … [Read more...]
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