The "One-Way Ratchet": Aetna Settlement Highlights Ongoing DOJ Crackdown on MA Upcoding - Whistleblower Partners LLP DOJ announces $117.7M Aetna settlement over Medicare Advantage upcoding, highlighting continued scrutiny of inflated risk adjustment practices.

Partner @maryinman.bsky.social reports on DOJ’s $117.7M #FalseClaimsAct settlement with Aetna over alleged Medicare Part C risk score manipulation. This latest DOJ action follows others, some of which led by Whistleblower Partners clients like Dr. James Taylor and Teresa Ross.

Elizabeth Soltan: After decades of trying, Pa. needs to pass a state False Claims Act Gov. Josh Shapiro urged Pennsylvania to pass a state False Claims Act (FCA) in his 2026 budget address. There is bipartisan support for House Bill 1697, which would create a state FCA modeled after th...

@triblive.bsky.social published Philadelphia native Liz Soltan’s Op-Ed urging Pennsylvania to pass a state #FalseClaimsAct. Without it, PA loses 10% in Medicaid recoveries and whistleblower support, a critical fraud enforcement tool. As @governor.pa.gov says, “Let’s finally get it done."

Aetna Agrees to Pay $117.7 Million to Resolve False Claims Act Allegations Aetna Inc., a national insurer incorporated under the laws of Pennsylvania, has agreed to pay $117,700,000 to resolve allegations that it violated the False Claims Act by submitting or failing to…

Let’s see, what novel #FalseClaimsAct liability theory has DOJ come up with this . . . oh never mind. Consult with counsel. Get a #compliance program in place. Do the work. The feds don’t need new theories when they can recycle the old ones. 

Aetna Agrees to Pay $117.7 Million to Resolve False Claims Act Allegations Aetna Inc., a national insurer incorporated under the laws of Pennsylvania, has agreed to pay $117,700,000 to resolve allegations that it violated the False Claims Act by submitting or failing to withdraw inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan enrollees in order to increase its payments from Medicare.

Aetna agrees to pay $117.7 M to resolve False Claims Act allegations over inflated Medicare Advantage payments.
www.justice.gov/opa/pr/aetna-agrees-pay-...

#Medicare #FalseClaimsAct #HealthcareCompliance #DOJ

Fierce Healthcare: Aetna to pay $117.7M to settle Medicare Advantage upcoding allegations #Whistleblower #FalseClaimsAct www.fiercehealthcare.com/payers/aetna...

Ferguson v Lockheed Martin: #5thCir reverses dismissal of #FalseClaimsAct suit: first-to-file bar didn't prevent #quitam action alleging different mechanism for #fraud across military aircraft programs #concur #dissent #TINA #appellatesky #lawsky baffc.net/4sDu6u2

Why Providers Can’t Ignore CMS Audits - MedCity News At the end of the day, it doesn’t matter what your patient mix looks like; your notes can and will be pulled into audits. Waiting until CMS is at your doorstep isn’t a strategy — it’s a risk. Now is…

It’s good advice. I am working with an auditing firm to guide a physician practice client in the implementation of a #compliance program now. Don’t wait till it’s too late. #FalseClaimsAct #Medicare

Court challenge could chill reporting of research fraud, say whistleblower attorneys utah778/iStock The U.S. government recently announced a record $6.8 billion in False Claims Act settlements and judgments in 2025, the most in a single year since the law’s enactment 163 years ago.…

Court challenge could chill reporting of research fraud, say whistleblower attorneys retractionwatch.com/2026/02/11/f...

#Science #Research #AcademicResearch #ResearchMisconduct #ResearchIntegrity #AcademicSky #AcademicChatter #FalsifyingData #Whistleblower #Fraud #FalseClaimsAct #FCA #QuiTam

Insect Shield LLC and Co-Founder’s Estate Agree to Pay $1.4M to Settle False Claims Act Allegations Insect Shield LLC, located in North Carolina, and the Estate of Richard Lane, a co-founder and co-owner of Insect Shield, have agreed to pay a combined $1.4 million to resolve allegations that Insect…

Evergreen rule: engage counsel with any compliance questions when dealing with DOD. Press releases like this are an automatic bad look. People like the troops. #FalseClaimsAct

Traditions Health Agrees to Pay $34M to Resolve False Claims Act Liability Relating to Home Health Services Following Self Disclosure Traditions Health LLC (Traditions) has agreed to pay $34 million to resolve its civil liability under the False Claims Act for billing medically unnecessary home health claims to Medicare and…

DOJ continues to play the hits with the #FalseClaimsAct. This time it is medically unnecessary home health services coupled with #kickbacks the physicians. Wonder how much it would’ve been without the self disclosure. 

New HHS OIG Report Highlights FCA as Tool to Address Medicare Advantage Fraud Risk - Whistleblower Partners LLP HHS OIG issues updated Medicare Advantage compliance guidance, highlighting high-risk areas and warning of potential False Claims Act liability.

HHS OIG issued updated Medicare Advantage compliance guidance for the first time in 20+ years, highlighting high risk areas and warning of #FalseClaimsAct liability. The FCA has recovered $85B since 1986, including $60B from #healthcare fraud, driven largely by #whistleblowers.

Key Takeaways from DOJ’s FY 2025 False Claims Act Report

The Department of Justice’s FY 2025 False Claims Act (FCA) report highlights a historic year in enforcement, with $6.8 billion in settlements and judgments – the largest annual total in FCA history.

Read more: https://bit.ly/49KNwXi

#FalseClaimsAct #DOJ

DOJ's False Claims Act Report for FY 2025 Shows Biggest Total Monetary Recoveries Yet, Provides Insight on FY 2026 Priorities | Littler According to the Department of Justice’s (DOJ) January 16, 2026 press release, the DOJ reported a record $6.8 billion in settlements and judgments under the False Claims Act (FCA) for the fiscal year ...

Record-breaking alert: The DOJ reports $6.8B in False Claims Act recoveries for FY 2025 – more than double the prior year. https://bit.ly/4qtUvtv
#FalseClaimsAct #DOJ #FCAEnforcement #RegulatoryUpdates

🗞️Newsletter! conta.cc/4qEPqyH
⚠️US gov. designates #Palestinian NGOs & branches of the #MuslimBrotherhood as terrorist orgs
🎥Webinar recording: International Day Against UCMs
⚖️Issue Brief: #FalseClaimsAct lawsuits targeting #nonprofits
❓FAQs on communications w/ designated groups
+more featured

DOJ Reports Record-Breaking $6.8 Billion in False Claims Act Recoveries for Fiscal Year 2025 - Whistleblower Partners LLP DOJ reports a record $6.8 billion in False Claims Act recoveries for FY 2025, driven by whistleblower cases and a surge in qui tam filings.

DOJ reports a record $6.8 billion in #FalseClaimsAct recoveries in FY 2025, highlighting the vital role #whistleblowers play in exposing #fraud across industries.

What do you know? More alleged #kickbacks in diagnostic testing. Please, physicians and physician groups, if it sounds too good to be true, consult with counsel. #healthcare #FalseClaimsAct

Another giant #FalseClaimsAct settlement involving the alleged manipulation of diagnosis codes in #Medicare Advantage plans. DOJ is playing the hits. #healthcare

South Carolina Laboratory Pleads Guilty and Agrees to Pay At Least $6.8M to Settle Allegations of Kickbacks to Doctors Clinical laboratory LTD Holding LLC, formerly known as Labtech Diagnostics LLC (Labtech), of Anderson, South Carolina, and its founder and CEO Joseph Labash, of the United Arab Emirates, have agreed…

Death. Taxes. #FalseClaimsAct settlements involving allegations of labs paying #kickbacks to physicians. Please, if you are a physician and it sounds too good to be true, talk to counsel. #healthcare www.justice.gov/opa/pr/south...

Updated Issue Brief: False Claim Act Lawsuits: What Nonprofits Need to Know - Charity & Security Network This updated issue brief includes new information about how False Claim Act lawsuits targeting nonprofit organizations (NPOs) have reemerged under the second Trump Administration, with the nonprofit s...

See our updated issue brief outlining everything #nonprofits need to know about the #FalseClaimsAct: How it can be weaponized against legitimate programs, what nonprofits can do to protect themselves, & new threats arising under Trump 2.0. 👇
bit.ly/3YC8Jw4

Podcast Episode

On Monitor Monday, Max Voldman discussed CVS Health’s $38M settlement resolving five #FalseClaimsAct cases over insulin pen billing. This includes premature refills and false days of supply. CVS and its subsidiaries now face roughly $1B in FCA liability.

The Eleventh Circuit is set to hear arguments on whether the False Claims Act’s qui tam provisions violate Article II of the Constitution—a case that could pave the way for Supreme Court review in 2026.

Read the full report here: https://bit.ly/3Yl7JMD

#FalseClaimsAct

Wiley's Diana Shaw breaks down what may constitute "illegal DEI" and emphasizes the importance of proactive #compliance, outlining practical steps organizations can take now to mitigate risk. Watch the video now: https://bit.ly/4otOsn7
#FalseClaimsAct

Sara McLean has joined Akin as a regulatory and health care & life sciences partner in Washington, D.C., bolstering the firm’s premier regulatory group and False Claims Act.

Read more here: https://bit.ly/43VLdgP

#FalseClaimsAct

FALSE CLAIMS ACT AND CYBERSECURITY: A Survival Guide For Federal Contractors Facing New Frontiers

FALSE CLAIMS ACT AND CYBERSECURITY: A Survival Guide For Federal Contractors Facing New Frontiers
rosecoveredglasses.wordpress.com/2025/11/13/f...
#GovernmentContracting #Cybersecurity #FalseClaimsAct #FCA

Learning From Whistleblower Cases In California In recent years, I've noticed the collision between economic targets and ethical boundaries has become increasingly visible across California’s corporate landscape.

Learning From Whistleblower Cases In The Corporate Environment In California

www.forbes.com/councils/for...

#Whistleblower #EmployeeRights #CorporateMisconduct #FalseClaimsAct #WorkplaceSafety

Gentry v Encompass Health: #5thCir affirms dismissal of #FalseClaimsAct qui tam action alleging false presentment, false reporting & conspiracy by inpatient rehab facility: complaint insufficiently plausible/particular #concur #appellatesky #lawsky baffc.net/4qMDfjS

New Economic Study: Healthcare Whistleblowers Save Government 10x Settlement Amounts - Whistleblower Partners LLP Whistleblowers save taxpayers billions. A study by Boston University’s Professor Jetson Leder-Luis found that $1.9 billion in False Claims Act settlements generated nearly $19 billion in #Medicare sav...

#Whistleblowers save taxpayers billions. A recent Boston University study by Professor Jetson Leder-Luis found $1.9B in #FalseClaimsAct settlements generated nearly $19B in #Medicare savings. Whistleblower lawsuits are a low-cost, effective way to fight fraud and protect public funds.

Semler Scientific Inc. and Bard Peripheral Vascular Inc. to Pay Nearly $37M to Resolve False Claims Act Allegations Relating to FloChec and QuantaFlo Devices Semler Scientific Inc. has agreed to pay $29.75 million and its former distributor, Bard Peripheral Vascular Inc. and its related companies, has agreed to pay $7.2 million to resolve allegations that…

DOJ have given us another reminder about the importance of coding #compliance. If your company does not have a program in place, please talk to counsel about how to implement one. #FalseClaimsAct #healthcare www.justice.gov/opa/pr/semle...

Fake or inflated Medicare claims cost taxpayers billions. Whistleblowers who expose these schemes not only protect patients, but may also earn significant rewards under the False Claims Act. ifightforyourrights.com/whistleblowe...
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#MedicareFraud #WhistleblowerJustice #FalseClaimsAct

U.S. files complaint against Inland Empire Health Plan for making allegedly false statements, retaining overpayments The complaint says that the Inland Empire Health Plan, also known as IEHP, allegedly made false statements and retained overpayments.

U.S. files complaint against Inland Empire Health Plan for making allegedly false statements, retaining overpayments

www.cbsnews.com/losangeles/n...

#FalseClaims #MedicareFraud #FalseClaimsAct #IEHP