I recently provided insight about the potential shift in healthcare fraud oversight amid federal changes and several recent cases that could narrow the scope of investigations and ultimately lower costs that health systems spend to fight fraud allegations.
Continue Reading Potential Shift in Healthcare Fraud OversightDOJ Settlement Highlights Customs, FCA Risks for Importers
On March 25, 2025, the U.S. Department of Justice (DOJ) announced an $8.1 million settlement in a civil case under the False Claims Act (FCA) related to alleged customs evasion by a California importer of wood flooring. The private whistleblower who reported the conduct received over $1.2 million in the matter. As we suggested in a blog post in February, these sorts of enforcement actions will proliferate under the Trump DOJ.
Continue Reading on the GovCon & Trade blog
Seoul Medical Group and Renaissance Imaging Medical Associates Settle Medicare Risk Adjustment Fraud Case for $62 Million
The Department of Justice announced this week that California-based primary care provider Seoul Medical Group, Inc. (SMG), SMG’s former president and majority owner, and California-based radiology group Renaissance Imaging Medical Associates Inc. (Renaissance) will pay a combined $62.85 million to resolve allegations of False Claims Act violations related to the submission of unsupported diagnosis codes to Medicare Advantage Organizations in order to increase reimbursement from the government.
Continue Reading Seoul Medical Group and Renaissance Imaging Medical Associates Settle Medicare Risk Adjustment Fraud Case for $62 MillionFalse Claims Act Enforcement in Healthcare: Insights from the 13th Annual Fraud & Abuse Review
The False Claims Act (FCA) remains one of the government’s most powerful tools in combating healthcare fraud, with a growing focus on opioid-related cases and violations of the Anti-Kickback Statute.
Continue Reading False Claims Act Enforcement in Healthcare: Insights from the 13th Annual Fraud & Abuse ReviewDownload Now – 13th Annual Healthcare Fraud & Abuse Review
Our 13th annual Healthcare Fraud & Abuse Review, compiled by the Bass, Berry & Sims Healthcare Fraud & Abuse Task Force, is now available, providing an in-depth look at the key enforcement trends, legal decisions, and settlements shaping the healthcare industry in 2024.
Continue Reading Download Now – 13th Annual Healthcare Fraud & Abuse ReviewRegister Now | Healthcare Fraud & Abuse Annual Review Webinar
Bass, Berry & Sims will release its 13th Annual Healthcare Fraud & Abuse Review the first week of March. As a companion to the Review, we will host a complimentary webinar on Thursday, March 20 from 11:00 a.m. – 1:00 p.m. CT, which will provide an overview and discussion of key focus areas covered in the Review.
Continue Reading Register Now | Healthcare Fraud & Abuse Annual Review WebinarSupreme Court Clarifies “Claim” Definition Under False Claims Act
In Wisconsin Bell, Inc. v. United States ex rel. Heath, the Supreme Court clarified the definition of “claim” under the FCA. The case resolves a split between the Fifth and Seventh Circuits on whether a request for reimbursement under the E-Rate subsidies program meets the statutory definition of a “claim.”
Continue Reading Supreme Court Clarifies “Claim” Definition Under False Claims ActFirst Circuit Adopts “But-For” Causation Standard for Proving Kickback FCA Violations
In a closely watched appeal, the U.S. Court of Appeals for the First Circuit ruled on February 18 that to satisfy the causation requirement in False Claims Act (FCA) actions based on alleged Anti-Kickback Statute (AKS) violations, the government or relator must prove that the alleged kickbacks were the “but-for” cause of the defendant’s allegedly false claims. The First Circuit joins the Sixth and Eighth Circuits in adopting this defendant-favorable standard, with only the Third Circuit requiring a less-stringent showing.
Continue Reading First Circuit Adopts “But-For” Causation Standard for Proving Kickback FCA ViolationsThe Surge in FCA Whistleblower Lawsuits: What’s Driving the Trend and What Comes Next?
Whistleblower-driven False Claims Act (FCA) lawsuits are on the rise, raising critical questions about the factors fueling this trend and its potential impact on enforcement.
Continue Reading The Surge in FCA Whistleblower Lawsuits: What’s Driving the Trend and What Comes Next?Fourth Circuit Holds that Violation of CIA Can Support Reverse False Claims and Adopts Relaxed Rule 9(b) Presentment Requirement
On February 3, the U.S. Court of Appeals for the Fourth Circuit reversed a district court’s grant of a motion to dismiss, holding in relevant part that:
Continue Reading Fourth Circuit Holds that Violation of CIA Can Support Reverse False Claims and Adopts Relaxed Rule 9(b) Presentment Requirement