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
Quarterly Case & Settlement Updates
The Villages Health System Settles Medicare Advantage Risk-Adjustment Allegations for $541.5 Million
By Lindsey Fetzer & Ellen Pasquale on
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
By Richard Arnholt & Tim K. Garrett on
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 ProvidersFalse Claims Act Settlements to Know from the First Half of 2025
With the first half of 2025 in the rearview mirror, the government’s continued focus on False Claims Act (FCA) enforcement shows no signs of slowing. In fact, the Department of Justice recently announced the results of a record-setting National Health Care Fraud Takedown, which resulted in criminal charges against 324 defendants for alleged healthcare fraud schemes involving over $14.6 billion.
Continue Reading False Claims Act Settlements to Know from the First Half of 2025False Claims Act Decisions to Know from Q3 2024
By Charlotte Elam & Reagan Schmidt on
Courts have addressed multiple False Claims Act (FCA) issues in the third quarter of this year. Below is a summary of top cases involving the constitutionality of the FCA’s qui tam provisions, the FCA’s scienter requirement, the public disclosure bar, and proof required under the FCA’s anti-retaliation provision.
Continue Reading False Claims Act Decisions to Know from Q3 2024False Claims Act Settlements to Know from Q3 2024
By Taylor Chenery & Hannah Webber on
The third quarter of this year brought numerous high-dollar False Claims Act (FCA) settlements involving a variety of industries and alleged conduct.
Continue Reading False Claims Act Settlements to Know from Q3 2024False Claims Act Decisions to Know from Q2 2024
By Molly Ruberg & Hannah Webber on
Posted in Quarterly Case & Settlement Updates
In case you missed it, this post recaps some key False Claims Act (FCA) decisions and case updates from the second quarter of this year. Courts weighed in on the FCA’s anti-retaliation provision, its first-to-file bar, and issues around judgments and awards.
Continue Reading False Claims Act Decisions to Know from Q2 2024False Claims Act Settlements to Know from Q2 2024
By Scott Gallisdorfer & Bass, Berry & Sims on
Halfway through 2024, the government’s False Claims Act (FCA) enforcement efforts show few signs of letting up. Last month alone, the Department of Justice (DOJ) announced at least five eight-figure FCA settlements, resolving allegations ranging from unlawful kickbacks to upcoding to improper subcontracting to cybersecurity violations.
Continue Reading False Claims Act Settlements to Know from Q2 2024False Claims Act Settlements to Know from Q1 2024
Despite the recent downward trend in DOJ healthcare industry settlements, the first quarter of 2024 saw many noteworthy False Claims Act (FCA) and civil healthcare fraud settlements related to alleged kickbacks, medically unnecessary services and equipment, pharmaceutical issues and Controlled Substances Act violations.
Continue Reading False Claims Act Settlements to Know from Q1 2024