Over the last several months, there has been no shortage of commentary about the Department of Justice’s (DOJ) Fraud Oversight through Careful Use of Statistics (FOCUS) initiative and the rise of data-driven False Claims Act (FCA) investigations. DOJ has made clear that it is increasingly interested in sophisticated analytics, statistical models, and “data miner” relators
Inside the False Claims Act
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DOJ’s Expanding Healthcare Fraud Enforcement Efforts
By John Eason
I recently provided insight for a Modern Healthcare article that examines the Department of Justice’s (DOJ) increased healthcare fraud enforcement efforts and growing use of artificial intelligence (AI) and data analytics in civil investigations. While whistleblower complaints continue to account for a substantial share of False Claims Act recoveries, the article highlights how enforcement agencies…
Kaiser Permanente Affiliates Settle Medicare Risk Adjustment Fraud Case for $556 Million
On January 14, the Department of Justice (DOJ) announced that five Kaiser Permanente affiliates agreed to pay $556 million to resolve allegations that they violated the False Claims Act (FCA) by submitting unsupported diagnosis codes for Medicare Advantage (MA) beneficiaries to increase reimbursement from the federal government. The relators will receive approximately $95 million as their share of…
Rare (c)(2)(A) Dismissal of Long-Running FCA Case
We were quoted in a Law360 article summarizing a September 2025 decision by a Utah federal court to dismiss False Claims Act (FCA) allegations against our clients. …
Exploring the DOJ’s Use of AI in Healthcare Fraud Enforcement
By Matt Curley
TIn one of its largest coordinated enforcement efforts to date, the Department of Justice recently announced charges against more than 300 defendants in connection with alleged healthcare fraud schemes.…