Key Federal and State False Claims Act (FCA) Developments

This alert seeks to bring you up to speed on key federal and state FCA developments.

Key Enforcement Priorities

DOJ identified the following as top targets of its enforcement efforts:

  • Military procurement fraud
  • Healthcare fraud
  • Fraud in pandemic relief programs
  • Violations of cybersecurity requirements in government contracts and grants.

DOJ Announces FY2024 FCA Statistics

On January 15, the Department of Justice (DOJ) announced that recoveries under the False Claims Act (FCA) for civil cases in fiscal year 2024 amounted to roughly $2.9 billion, marking an increase of approximately $200 million compared to 2023. Notably, this total does not include two significant settlements reached shortly after the fiscal year ended, which would have added an additional $830 million. Of the total amount recovered in 2024, approximately $1.67 billion (58%) was related to the healthcare sector. This included enforcement actions against a range of providers, such as managed care organizations, hospitals, pharmacies, pharmaceutical companies, laboratories, and physicians. Although the percentage of recoveries linked to healthcare decreased compared to previous years, the healthcare industry remains the primary focus of scrutiny.

Taxi Company Owners Convicted for Stealing Millions from Medicaid

On December 5, 2025, New York Attorney General Letitia James announced that certain individuals and their transportation companies pleaded guilty to stealing more than $4.4 million from New York’s Medicaid program through fake billing and illegal kickbacks, as well as engaging in money laundering and other fraudulent schemes to conceal their crimes.

Medicare Telehealth Waivers Extended through March 31

The American Relief Act, 2025, signed into law on December 21, 2024, included a short-term extension of certain telehealth waivers that went into effect during the COVID-19 pandemic.  Certain of these waivers, including those for telehealth services provided to Medicare beneficiaries, were originally set to expire on December 31, 2024 but have now been extended until March 31, 2025.

Former Hospital CEO Sentenced to Prison for Violations of the Federal Anti-Kickback Statute

A former Texas hospital chief executive officer, Jeffrey Paul Madison, was recently sentenced to 36 months in federal prison for conspiring to violate the federal Anti-Kickback Statute (“AKS”).  Madison also agreed to pay over $5.3 million to settle allegations under the False Claims Act involving illegal payments to physicians for laboratory referrals in violation of the AKS.  Other co-conspirators were also charged with lesser prison sentences and monetary fines.

RN and NP Training Requirements, Updated

As a condition of licensure, all registered nurses and nurse practitioners must have documented training in the identification and reporting of child abuse and maltreatment. Nurses are just one of the many professions considered “mandated reporters” that are subject to this one-time training requirement. As a result of a Social Services law change in the Laws of 2021, the mandated reporter training requirements also include additional training which includes: (a) protocols to reduce implicit bias in decision-making processes (b) strategies for identifying adverse childhood experiences  (c) guidelines to assist in recognizing signs of abuse or maltreatment while interacting virtually

NYS OMIG RELEASES 2025 WORK PLAN

The NYS Office of the Medicaid Inspector General (OMIG) released its Work Plan (the Plan) for 2025. The Plan outlines OMIG’s priorities for its key program integrity initiatives for the next 12 months and serves as a roadmap for stakeholders including providers, policymakers, payors, and citizens. While comprehensive, the Plan is not an exhaustive list of OMIG ‘s initiatives for the upcoming year and may be updated to include new or other initiatives.