Category: Healthcare
On August 4, 2026, the Justice Department’s National Fraud Enforcement Division announced the initiation of a new Strike Force to aggressively combat Medicaid fraud in Philadelphia, Pennsylvania. This expansion of the Division’s Northeast Health Care Fraud Strike Force, in conjunction with the expansion of the West Coast Strike Force, displays the government’s commitment to investigating and prosecuting healthcare fraud.
On April 30, 2026, the Department of Justice (DOJ) launched the West Coast Health Care Fraud Strike Force to target schemes in Arizona, Nevada, and the Northern District of California. The initiative reflects a coordinated effort to expand western enforcement resources and to advance data-driven approaches against fraud involving taxpayer-funded programs.
Takeaway: Laboratory fraud continues to be pervasive in the healthcare industry.
Every sector of the healthcare industry relies upon laboratory testing. Lab tests are used to diagnose virtually all illnesses and conditions ranging from the common flu to cancer. The average American receives their first lab test, in the form of genetic testing,
Takeaway: Wound care fraud is now one of the key enforcement priorities of the Department of Justice. An aging population, combined with Medicare’s pricing policies, nurtured an opportunity for Amniotic Allograft Fraud to explode.
Approximately 8.8 million Americans suffer from chronic wounds (wounds that are present for four weeks or more without signs of healing),
Late last month, the federal government announced a False Claims Act settlement with Summit BHC New Jersey, LLC, d/b/a Seabrook (“Seabrook”), a prominent New Jersey Drug & Alcohol Rehabilitation facility. The joint settlement with the New Jersey Attorney General’s Office, in the amount of $19,751,762.69, covered claims submitted by Seabrook under the Medicaid program and Department of Veterans Affairs benefit programs.
For at least five years, under both Republican and Democrat administrations, there has been a focus on private equity actors in the healthcare space. Since at least 2020, the Department of Justice (DOJ) has focused on private equity in enforcement efforts. In 2023, during the Biden administration, the Senate conducted a bipartisan investigation of the effect that private equity could have on the healthcare industry.
In a significant ruling, the Second Circuit Court of Appeals recently expanded the scope of the Anti-Kickback Statute (AKS). The Court joined other circuit courts across the country in adopting, for the first time, the “at-least-one-purpose rule,” whereby a defendant violates the AKS when at least one purpose,
Senate testimony focusing on the impact of the rising presence of private equity (PE) firms’ control of major healthcare providers touched on the “substantial overlap between the risks associated with private equity ownership of healthcare companies and the activities targeted by the False Claims Act (FCA), a federal law that establishes liability for individuals or companies that defraud governmental programs.” See O’Grady Statement.pdf (senate.gov).
As experienced whistleblower counsel, with more than a decade of representing emergency providers in false claims act (FCA) cases against large hospital systems and national hospital-based staffing groups, the recent investigation by the US Senate into the impact of private equity on emergency care is no surprise.
Takeaways:
- FY 2023 saw the most FCA settlements and judgments ever.
- $2.69B in total recoveries is an uptick from 2022’s down year but still below historical norms.
- New non-qui tam cases surged to the highest in history as the Department of Justice’s pandemic fraud crackdown gains steam.
