In a much-anticipated False Claims Act (FCA) ruling, the Eleventh Circuit has joined every other circuit in considering the issue and holding that qui tam relators under the FCA are not “officers of the United States” subject to the Constitution’s Appointments Clause, thereby rejecting the constitutional challenge to the FCA’s qui tam provisions on that narrow ground.
Continue Reading Eleventh Circuit Upholds FCA Qui Tam Provisions Against Appointments Clause Challenge
Medicare Advantage Fraud Enforcement in 2026: What Recent Settlements Reveal About the Limits of Data-Driven False Claims Act Cases
Over the last several months, there has been no shortage of commentary about the Department of Justice’s (DOJ) Fraud Oversight through Careful Use of Statistics (FOCUS) initiative and the rise of data-driven False Claims Act (FCA) investigations. DOJ has made clear that it is increasingly interested in sophisticated analytics, statistical models, and “data miner” relators who use large public datasets to identify potential fraud.
Continue Reading Medicare Advantage Fraud Enforcement in 2026: What Recent Settlements Reveal About the Limits of Data-Driven False Claims Act Cases
The Villages Health System Settles Medicare Advantage Risk-Adjustment Allegations for $541.5 Million
On August 26, the Department of Justice (DOJ) announced that The Villages Health System, LLC (TVH), a healthcare provider group located within The Villages retirement community in central Florida, agreed to a $541.5 million settlement to resolve False Claims Act (FCA) allegations related to Medicare Advantage risk-adjustment diagnosis codes. The same announcement linked two related settlement agreements, separately executed in late July 2026, where UnitedHealthcare and Florida Blue resolved overpayment recoupment obligations resulting from the same underlying conduct.
Continue Reading The Villages Health System Settles Medicare Advantage Risk-Adjustment Allegations for $541.5 MillionDeloitte DEI Settlement Highlights False Claims Act Risk at Both Federal and State Levels
The U.S. Department of Justice (DOJ) announced on August 25 that Deloitte has agreed to pay $21.5 million to resolve allegations that certain diversity, equity, and inclusion (DEI) practices discriminated against employees and applicants based on race or sex and caused the company to submit false claims for payment under federal contracts. The settlement is
Medicaid Fraud Enforcement in 2026: High-Risk Areas for Home Care, Behavioral Health and Skilled Nursing Providers
As described in a previous blog post, the 2026 DOJ Health Care Fraud Takedown reflects an increased enforcement focus on Medicaid. Because Medicaid dollars are both federal and state in origin, a single set of allegations can expose a provider to federal FCA liability, state false claims liability, MFCU investigation, state administrative remedies, and HHS-OIG oversight at once. Three areas in particular have drawn recent enforcement attention.
Continue Reading Medicaid Fraud Enforcement in 2026: High-Risk Areas for Home Care, Behavioral Health and Skilled Nursing ProvidersWhat Happens in Vegas…Gets DOJ’s Attention: $95M Wound Care Fraud Indictment
On August 5, the U.S. Department of Justice (DOJ) announced that a federal grand jury in the District of Nevada returned a six-count indictment charging Stephen Dubin, M.D., of Henderson, Nevada, with conspiracy to commit healthcare fraud and five counts of healthcare fraud. The charges against Dr. Dubin arise from an alleged scheme to defraud Medicare of approximately $95 million through the billing of medically unnecessary amniotic wound allografts to elderly Medicare beneficiaries as well as alleged kickbacks and rebates from two allograft distributors; sham full-price invoices; and, as to one distributor, a pass-through bank account held in the name of a shell company. According to DOJ, Medicare paid over $54 million on the allegedly fraudulent claims.
Continue Reading What Happens in Vegas…Gets DOJ’s Attention: $95M Wound Care Fraud Indictment
DOJ’s $6.5 Billion National Health Care Fraud Takedown Signals a New Era of Data-Driven Enforcement
The Department of Justice (DOJ) recently announced the largest National Health Care Fraud Takedown in its history, charging 455 defendants—including 90 physicians and other licensed medical professionals—in schemes involving more than $6.5 billion in alleged false claims.
Continue Reading DOJ’s $6.5 Billion National Health Care Fraud Takedown Signals a New Era of Data-Driven EnforcementSmoke is Not Fire: Fourth Circuit Rejects Stark and AKS Theories Built on Ordinary Business Practices and Conclusory Allegations
It is not every day that an 83-page qui tam complaint alleging Stark Law and Anti-Kickback Statute (AKS) violations is dismissed at the pleading stage, particularly when filed by experienced relator’s counsel and accompanied by more than 30 pages of detailed claims data. But that was exactly the result in U.S. ex rel. Kyer v. Thomas Health System, a June 4 decision from a unanimous Fourth Circuit panel.
Procurement Fraud Enforcement Trends Continue Into 2026
As procurement fraud enforcement continues to be a priority for the Department of Justice and other federal agencies, we take a look back at significant 2025 enforcement developments affecting government contractors, grant recipients and participants in federal programs in our 2025 Procurement Fraud Review.
Continue Reading Procurement Fraud Enforcement Trends Continue Into 2026Legal Hurdles in Using FCA to Challenge DEI Programs
In a recent article for Law360, I examined the significant challenges the Department of Justice (DOJ) may face as it seeks to use the False Claims Act (FCA) to pursue allegedly unlawful diversity, equity, and inclusion (DEI) practices.
Continue Reading Legal Hurdles in Using FCA to Challenge DEI Programs