News
Hawaii's fight against Medicaid fraud plagued for over a decade
31+ min ago (1666+ words) Behind the verbal sparring last week between federal and state officials over policing Medicaid fraud, data shows Hawaii's recent record on the subject is in some respects worst in the nation. In each of the last four years, Hawaii's Medicaid…...
IBM Agrees to First Settlement of False Claims Act Allegations under DOJ Civil Rights Fraud Initiative
6+ day, 17+ hour ago (95+ words) On April 10, 2026, the United States Department of Justice (DOJ) announced the first False Claims Act resolution secured under the Civil Rights Fraud Initiative with International Business Machines Corporation (IBM). We have previously reported on the Civil Rights Fraud Initiative, which…...
Federal Scrutiny of State Medicaid Programs and Medicaid Providers Intensifies
4+ day, 6+ hour ago (156+ words) Here, "revalidation" refers to provider enrollment screening, not beneficiary eligibility renewals. Provider revalidation confirms enrollment information, credentials, ownership and practice details. It is separate from member re-enrollment, new work requirements or eligibility redeterminations, which are already coming as a result…...
DOJ Settlement Highlights False Claims Act Exposure for Certain DEI Practices
5+ day, 5+ hour ago (252+ words) The DOJ's Civil Rights Fraud Initiative is specifically tasked with utilizing the False Claims Act to investigate and pursue claims against federal contractors that engage in "illegal" DEI." Any person who submits false claims to the government is liable for…...
DOJ's New FOCUS Initiative Solicits More Qui Tam Filings by Sophisticated "Data Miners" Who Mine Publicly Available Data" What It Means for False Claims Act Practice
6+ day, 7+ hour ago (805+ words) Overview - On April 30, 2026, the U. S. Department of Justice (DOJ," or the Department") Civil Division announced the Fraud Oversight through Careful Use of Statistics (FOCUS") initiative to improve the quality of referrals from data miners and to strengthen DOJ's working relationship with…...
Medicaid Behavioral Health Investigations and Payment Suspensions in D. C. Are Increasing " How Providers Can Limit Risk
3+ day, 17+ hour ago (195+ words) Behavioral health providers in the District of Columbia (District" or D. C.") are operating in an environment of heightened government scrutiny. The penalty for these crimes is significant " including possible jail time and restitution that can be in the hundreds of thousands…...
DOJ's New West Coast Strike Force Puts Health Care Providers on Notice
1+ week, 2+ day ago (692+ words) On April 30, 2026, the Department of Justice's (DOJ) National Fraud Enforcement Division (Fraud Division) announced the formation of the West Coast Health Care Fraud Strike Force, a multi-district enforcement initiative spanning Arizona, Nevada, and the Northern District of California. .. .By: Mc…...
DOJ's West Coast Health Care Fraud Strike Force: What LTC Facilities Need to Know
4+ day, 14+ hour ago (349+ words) The U. S. Department of Justice (DOJ) recently announced the formation of the West Coast Health Care Fraud Strike Force, a multidistrict initiative targeting health care fraud across Arizona, Nevada, and Northern California. Long-term care facilities and other health care providers should…...
Fake Doctors, Fabricated Reports and Illegal Hospitals: Major Medical Fraud Network Exposed
5+ hour, 42+ min ago (514+ words) The420. in A major alleged network of hospitals operating on the basis of fake medical degrees and forged medical documents has surfaced in western Uttar Pradesh, triggering concern within the health department and law enforcement agencies. A complaint filed against Sahara…...
HHS OIG Sends a Strong Warning to State Medicaid Fraud Control Units: Signals Aggressive Federal Oversight of State Medicaid Fraud Enforcement
3+ day, 15+ hour ago (786+ words) On May 13, 2026, the U. S. Department of Health and Human Services Office of Inspector General (HHS OIG) sent a letter to the Attorneys General of every state warning that the federal government will impose strict compliance requirements on the state's Medicaid Fraud…...