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Foley Health Care Law

5 stories

Court Dismisses False Claims Act Case on Medicare Advantage Marketing Practices

A federal court dismissed a sealed False Claims Act case alleging Medicare Advantage marketing violations. The relator attempted to characterize patient acquisition and outreach activities as fraudulent claims for payment. The dismissal demonstrates judicial skepticism toward FCA theories targeting marketing conduct rather than false billing. The outcome matters for Medicare Advantage plans facing similar qui tam allegations linking enrollment practices to improper payment.

Foley

Legal·58d ago

DOJ Intensifies Medicaid Fraud Enforcement Under Trump Administration

The Trump Administration has significantly increased enforcement focus on waste, fraud, and abuse in Medicaid over the past six months, with the Department of Justice prioritizing False Claims Act cases against Medicaid providers and managed care organizations. This heightened scrutiny follows longstanding federal efforts to recover improper Medicaid payments but marks a notable acceleration in enforcement activity. The increased DOJ attention raises compliance and financial risk for Medicaid managed care plans, particularly around billing accuracy, utilization management, and encounter data reporting. Plans should expect more qui tam investigations and potential enforcement actions.

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Legal·72d ago

California Doctor Convicted in $45 Million Medicare Botox Fraud Scheme

A federal jury in the Central District of California convicted Dr. Violetta Mailyan for orchestrating a $45 million Medicare fraud scheme involving fraudulent Botox injection claims. The conviction reflects DOJ's increasing use of data analytics to identify and prosecute billing anomalies and fraud patterns in federal health programs. The case demonstrates heightened federal enforcement targeting suspicious billing practices, particularly for high-cost procedure codes and injectable medications. Medicaid managed care organizations face similar fraud detection scrutiny and should strengthen their claims review protocols and provider oversight mechanisms.

Foley

Legal·72d ago

DOJ Orders Fast-Track Review of Sealed Medicaid False Claims Act Cases

The Department of Justice announced May 27, 2026, that civil attorneys must prioritize and expedite sealed qui tam cases alleging fraud against Medicaid and other federally funded, state-administered benefit programs. Assistant Attorney General Brett Shumate directed DOJ Civil Division and U.S. Attorney's Office lawyers to fast-track these investigations. The directive applies immediately to pending sealed cases. This signals heightened federal enforcement scrutiny of Medicaid fraud allegations and may accelerate the timeline from complaint filing to government intervention decisions or unsealing.

Foley

Legal·72d ago

California Doctor Convicted in $45 Million Medicare Botox Fraud Scheme

A federal jury in California convicted Dr. Violetta Mailyan of orchestrating a $45 million Medicare fraud scheme involving fraudulent Botox injection claims. The case demonstrates the Department of Justice's increased use of data analytics to identify and prosecute healthcare fraud patterns. The conviction highlights DOJ's expanding capability to detect billing anomalies and target large-scale fraudulent schemes. This enforcement approach signals heightened scrutiny of provider billing patterns across Medicare and Medicaid programs, requiring managed care organizations to strengthen their fraud detection and provider monitoring systems.

Foley