Guidance on defending against payer and government audits, overpayment demands, and compliance investigations targeting healthcare providers.
June 8, 2026
Massachusetts Attorney General Andrea Campbell has filed a lawsuit against UnitedHealthcare, alleging that the insurer improperly secured more than $100 million in payments from MassHealth, the state’s Medicaid program.
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March 18, 2026
Aetna has agreed to pay $117.7 million to resolve allegations that it improperly inflated payments received through the Medicare Advantage program. The settlement, announced by the U.S. Department of Justice, resolves claims that the insurer violated the federal False Claims Act by submitting or failing to withdraw inaccurate diagnosis codes tied to beneficiaries enrolled in its Medicare Advantage plans.
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January 30, 2026
The U.S. Department of Justice announced a historic $6.8 billion in recoveries under the False Claims Act (FCA) for fiscal year 2025, marking one of the largest enforcement years in the statute’s history. Healthcare-related matters once again dominated recoveries, underscoring the federal government’s continued focus on billing accuracy, reimbursement compliance, and fraud prevention across public and private payor programs.
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November 24, 2025
New Jersey Attorney General Matthew Platkin announced a $100 million settlement resolving claims that Horizon Blue Cross Blue Shield misled the state to secure a contract administering health plans covering more than 750,000 public employees, retirees, and dependents.
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July 15, 2025
In June 2025, the Department of Justice (DOJ) announced the largest healthcare fraud enforcement action in U.S. history, charging 324 individuals in schemes totaling over $14.6 billion in intended losses. Known as “Operation Gold Rush,” the nationwide sweep included doctors, medical executives, and billing companies accused of exploiting federal and private healthcare programs.
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July 14, 2025
$31.5M DOJ Settlement: Fresno Community Hospital and Physicians Network Advantage paid to resolve allegations of violating the Anti-Kickback Statute and Stark Law through improper EHR-related incentives.
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June 18, 2025
Starting January 1, 2026, healthcare providers in Florida will be legally required to refund patient overpayments within 30 days of identification. Under the new Florida law, this applies to any licensed facility or practitioner that submits claims to government or private insurers. Providers should begin reviewing and updating their billing and refund protocols well ahead of the deadline.
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May 22, 2025
UnitedHealth Group Inc. is facing mounting scrutiny following a report that the company is the subject of a criminal investigation into its Medicare Advantage billing practices. According to a recent article from BenefitsPRO, the U.S. Department of Justice has been conducting the probe since at least mid-2024. Although UnitedHealth stated it has not been formally notified, the news triggered an 18% drop in the company’s stock, adding to a tumultuous week that included the sudden replacement of its CEO and the suspension of 2025 guidance.
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April 8, 2025
Recent reporting by The Wall Street Journal highlights a significant issue affecting state Medicaid programs: duplicate payments made to insurers due to beneficiaries being enrolled more than once. These billing errors have led to overpayments that, in some states, may amount to hundreds of millions of dollars. As states intensify efforts to audit and recover these funds, insurers and healthcare providers must be aware of the legal and compliance risks involved.
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April 7, 2025
A former global price risk manager for Mars Inc.'s Wrigley subsidiary, Paul R. Steed, has been indicted in federal court for allegedly embezzling over $28 million from the company. The indictment includes seven counts of wire fraud and two counts of tax evasion. Authorities say Steed allegedly used fake shell companies—MCNA LLC and Ibera LLC—to invoice Mars for services never rendered and reroute funds intended for the company into accounts he controlled.
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December 29, 2023
#### I wanted to provide summary of recent regulatory action of concern to the Healthcare Provider. This actual case can provide valuable guidance to the healthcare provider and assist their staff in creating policies and staff training to avoid these type of compliance issues.
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December 29, 2023
#### I wanted to provide weekly summaries of recent cases of concern to the Healthcare Provider. These actual cases and lawsuits can provide valuable guidance to the healthcare provider and assist their staff in creating policies and staff training to avoid these type of compliance issues. Our company defends these type of audit cases daily.
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June 29, 2023
Like many practices and providers, you may be of the belief that preauthorization will either guaranty payment for services rendered or, alternatively, should the carrier refuse to fairly compensate for such services, allow for a variety of legal claims to be brought in court. This belief, however, is often misguided as the U.S. District Court for the District of New Jersey just explained in Advanced Orthopedics & Sports Med. Inst., P.C. v. Oxford Health Ins., Inc. (Civil Action No. 21-17221).
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June 29, 2023
A chiropractor practicing in East Meadow pleaded guilty in federal court in Central Islip Monday to a $1 million healthcare fraud scheme, officials said.
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