News & Analysis as of

Medicare Advantage Managed Care Contracts Department of Justice (DOJ)

American Conference Institute (ACI)

[Event] 15th Annual Advanced Forum on Managed Care Disputes and Litigation - May 2nd - 3rd, Chicago, IL

ACI’s Advanced Forum on Managed Care Disputes and Litigation offers an unparalleled learning experience, specifically designed for the MCO legal community. Attend and develop winning legal strategies and business best...more

Bass, Berry & Sims PLC

Martin’s Point Health Care Inc.’s $22.4M Settlement Illustrates DOJ’s Focus on Part C Fraud

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Last week, the U.S. Department of Justice (DOJ) announced a $22.4 million settlement resolving allegations that Martin’s Point Health Care, Inc. (Martin’s Point) violated the False Claims Act (FCA) by submitting inaccurate...more

Foley & Lardner LLP

Managed Care & the FCA: Are Courts Getting It Right?

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Courts are grappling with unique questions in the context of managed care programs in False Claims Act (FCA) cases. But are they getting it right? Two questions trending in courts relate to: (1) materiality under the FCA when...more

ArentFox Schiff

Investigations Newsletter: DOJ Secures $5.6 Billion in False Claims Act Recoveries in Fiscal Year 2021 

ArentFox Schiff on

DOJ Secures $5.6 Billion in False Claims Act Recoveries in Fiscal Year 2021 - On February 1, 2022, the U.S. Department of Justice (DOJ) announced that the Department recovered approximately $5.6 billion in False Claims Act...more

Stoel Rives - Health Law Insider®

AKS and Medicare Advantage Plans: Don’t Kickback and Relax!

Health care attorneys have long questioned whether there are significant Anti-Kickback Statute (AKS) risks associated with financial transactions between Medicare Advantage plans and their participating providers. An ongoing...more

Dorsey & Whitney LLP

Sutter Health LLC Pays $30 Million to Settle Alleged Overpayment of Medicare Advantage Funds, but Faces Similar Allegations in...

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On April 12, 2019, the U.S. Department of Justice announced Sutter Health LLC—along with its affiliates Sutter East Bay Medical Foundation, Sutter Pacific Medical Foundation, Sutter Gould Medical Foundation, and Sutter...more

King & Spalding

California Insurance Commissioner Asks DOJ to Block Proposed Mergers

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On June 23, 2016, California Insurance Commissioner Dave Jones submitted a letter urging the Department of Justice, Antitrust Division (DOJ) to block the proposed merger between Aetna, Inc. (Aetna) and Humana, Inc. (Humana). ...more

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