On August 13, 2026, Assistant Attorney General Colin M. McDonald issued a memo entitled The Fraud Division’s Enforcement Priorities to all personnel of the Department of Justice’s (DOJ) new National Fraud Enforcement Division. As the title suggests, the memo sets out the division’s enforcement priorities. While the memo doesn’t break new ground, it highlights further
The autism therapy industry is a growing target for government enforcement. As I discussed recently in Emerging Target: Federal Enforcement Comes to the Autism Therapy Industry, Applied Behavior Analysis (ABA) therapy — currently the dominant type of autism therapy — has all the markers for healthcare fraud enforcement: explosive reimbursement growth, low barriers to
On June 23, 2026, the Department of Justice (DOJ) announced the results of the 2026 National Health Care Fraud Takedown. The so-called “takedowns” have become an annual event, and this year’s involved the largest number of defendants in Takedown history. For healthcare providers and organizations, the takeaway is clear: Enforcement is nationally coordinated, increasingly data-driven
The Department of Justice (DOJ) just issued a new memorandum that may reshape how the government handles False Claims Act (FCA) cases involving federally funded benefits programs. Signed by Assistant Attorney General Brett A. Shumate on May 27, 2026, the memo directs DOJ attorneys to accelerate their review and prosecution of whistleblower suits alleging fraud
Texas is again aggressively investigating and prosecuting dental and orthodontic fraud, particularly regarding Medicaid billing. In fact, in 2025 Attorney General Ken Paxton stated that the Medicaid Fraud Control Unit (MFCU) is heavily targeting pediatric dental chains that use “paper-only” visits, where the clinic bills for an exam that never actually occurred or was performed
The Department of Justice announced Friday that it obtained more than $6.8 billion in False Claims Act (FCA) settlements and judgments in the fiscal year ending September 30, 2025 (FY 2025). This is the largest total in a single year in FCA history, easily surpassing the $6.1 billion obtained in 2014.
Both recoveries and the
Addressing an issue of first impression, the First Circuit has clarified the burden to satisfy the knowledge element required in False Claims Act (FCA) cases in the context of laboratory testing and Medicare fraud. The Medicare Act permits reimbursement of diagnostic laboratory tests only if they are “reasonable and necessary” for diagnosis or treatment of
On September 5, 2025, the U.S. Securities and Exchange Commission (SEC) brought enforcement actions against a public company and one of its executives for materially misleading statements. Although disclosure fraud cases are nothing new for the SEC, they have been a rarity thus far during the tenure of Chairman Paul S. Atkins. So, these cases
It has long been the law of the Eleventh Circuit that, under the False Claims Act (FCA) and Federal Rule of Civil Procedure 9(b), a relator must provide sufficient “indicia of reliability … to support the allegation of an actual false claim for payment being made to the government.” U.S. ex rel. Clausen v. Laboratory
On February 18, 2025, the First Circuit joined the Sixth and Eighth Circuits in adopting a “but for” causation standard in cases involving per se liability under the federal Anti-Kickback Statute (AKS) and the False Claims Act (FCA). In U.S. v. Regeneron Pharmaceuticals, the First Circuit held that for an AKS violation to automatically