Healthcare fraud
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Medicare Advantage risk-coding dispute ends in $117.7m Aetna settlement
Insurer agreed to resolve US allegations that inaccurate diagnosis data for plan members inflated risk-adjusted payments from federal Medicare program.
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FCA Healthcare roundup: Three cases of billing medically unnecessary products and services
Our in-brief, biweekly roundup of notable DOJ False Claims Act cases related to healthcare fraud.
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Texas DME operator receives 7.5 years in prison for $59m Medicare fraud scheme
The owner and operator of three DME companies paid illegal kickbacks to doctors for medically unnecessary orthotics braces to fund a lavish lifestyle.
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Insurance executive and marketing CEO sentenced in $233m ACA fraud scheme
Texts exchanged by the defendants revealed a scheme that targeted low-income individuals experiencing homelessness, unemployment, and other challenges.
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FCA Healthcare roundup: Three cases of Medicare and Medicaid fraud in IL, MN, NY
Our in-brief, biweekly roundup of notable US Department of Justice False Claims Act cases related to healthcare fraud.
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Former Seahawks tight end convicted in $200m healthcare fraud scheme
Joel Rufus French pressured elderly Americans to provide their personal and health insurance information and accept unnecessary orthotic braces.
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DOJ issues 2025 Year in Review, touts ‘ATM jackpotting’ indictment
In 2025, the DOJ’s Fraud Section charged 265 defendants, an increase of over 10% from 2024.
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A transformational 2025 in US healthcare – and more to come in 2026
In many ways, 2025 found the healthcare sector at a crossroads, with compliance officers holding their heads.