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
On June 28, 2024, SCOTUS overturned the long-standing Chevron doctrine in its decision Loper Bright Enterprises v. Raimondo and Relentless v. Department of Commerce. The Court’s ruling will have a significant impact on industries regulated by federal agencies, which historically have issued “guidance” interpreting the statutes, rules, and regulations they administer. As one of
In a first-of-its-kind prosecution, federal prosecutors have charged two healthcare executives with unlawfully distributing controlled substances, such as Adderall, through a telehealth website. These charges demonstrate the Department of Justice’s intensified focus on enforcing federal controlled substances laws in the rapidly evolving digital health landscape.
The government bases the bulk of its controlled substances charges
On Thursday, May 9, 2024, the Department of Justice announced the formation of a new task force to guide antitrust enforcement in the healthcare industry. The body, named the Task Force on Health Care Monopolies and Collusion (HCMC), is housed within DOJ’s Antitrust Division and directed by longtime DOJ antitrust prosecutor Katrina Rouse.
Recent years have seen eye-popping judgments and settlements involving cases brought under the federal False Claims Act (FCA) and federal Anti-Kickback Statute (AKS). And healthcare companies have, unsurprisingly, focused their compliance efforts on these and other federal fraud-and-abuse statutes. But a recent decision out of the Second Circuit underlines the importance of incorporating state-level anti-fraud