Latest news with #FalseClaimsAct
Business Wire
2 days ago
- Business
- Business Wire
CyberSheath Launches Revamped CMMC CON Ninja Training Program as Compliance Enforcement Intensifies
RESTON, Va.--(BUSINESS WIRE)--Defense contractors face mounting pressure to meet CMMC 2.0 requirements. The Department of Justice's intervention in False Claims Act cases involving NIST 800-171 violations shows that inadequate protection of controlled unclassified information now carries financial and legal risks beyond just losing contracts. Against this backdrop, CyberSheath has redesigned its popular ninja training program to focus on practical compliance execution. Registration is open now through July 18, 2025. The free program now features three intensive courses built around the company's proven AIM methodology: Assess, Implement, and Manage. Those who complete all three courses will earn recognition on the wall of fame at CMMC CON 2025 on Sept. 25, 2025, the closing of the two-day event. 'Contractors who thought they could delay CMMC preparation are now seeing real enforcement consequences, and this program helps them overcome that obstacle,' said Eric Noonan, CEO of CyberSheath. 'Our revamped training gives organizations the tactical knowledge they need to build genuine, audit-ready compliance programs.' Led by Casey Lang, CyberSheath's Vice President of Compliance, the streamlined program eliminates theoretical discussions in favor of hands-on guidance. Participants work through the three phases that determine compliance success: White Belt – Assess: Understanding your current security posture and mapping compliance gaps Blue Belt – Implement: Building and deploying effective security controls Black Belt – Manage: Maintaining ongoing compliance and assessment readiness Courses launch the week of July 21, with participants earning belts through completion of practical assessments. The training program complements CMMC CON 2025, which features the theme 'Compliance Blueprint – Plan. Execute. Certify.' Register for the two-day virtual conference and the ninja training program. About CyberSheath Established in 2012, CyberSheath is one of the most experienced and trusted IT security services partners for the U.S. defense industrial base. From CMMC compliance to strategic security planning to managed security services, CyberSheath offers a comprehensive suite of offerings tailored to clients' information security and regulatory compliance needs. Learn more at
Associated Press
3 days ago
- Business
- Associated Press
SelectQuote (SLQT) Shares Slide Further on Disappointing Earnings Amidst DOJ Scrutiny
SLQT Investors with Losses Encouraged to Contact the Firm SAN FRANCISCO, CA / ACCESS Newswire / June 17, 2025 / SelectQuote Inc. (NYSE:SLQT) faced renewed investor pressure on Monday, May 12, 2025, as its shares tumbled another 12% following the release of quarterly results that fell short of earnings and revenue expectations. This decline compounds the over 19% drop experienced on May 1st after the U.S. Department of Justice (DOJ) announced a lawsuit alleging violations of the False Claims Act against the insurance brokerage and several major health insurers. Hagens Berman is investigating potential violations of the U.S. securities laws and encourages SelectQuote investors who suffered substantial losses to submit your losses now. The firm also urges persons with knowledge who may be able to assist in the investigation to contact its attorneys. Visit: Contact the Firm Now: [email protected] 844-916-0895 Earnings Miss Adds to Investor Woes For the quarter ended March 2025, SelectQuote reported earnings of $0.03 per share, missing the Zacks Consensus Estimate of $0.04 per share. The company also posted revenues of $408.16 million, falling short of the Zacks Consensus Estimate of $417.01 million by 2.12%. Mounting Troubles Weigh on Investor Confidence This financial disappointment adds to the headwinds facing SelectQuote, which is already grappling with serious legal allegations. The DOJ lawsuit, unveiled on May 1st, accuses SelectQuote, along with other brokers and health insurance giants Aetna, Anthem, and Humana, of False Claims Act violations related to the marketing of Medicare Advantage (MA) plans. The lawsuit alleges that, from 2016 through at least 2021, insurers paid significant sums to SelectQuote and other brokers for Medicare Advantage enrollments. The DOJ contends that, rather than providing unbiased guidance, SelectQuote and other brokers steered beneficiaries toward plans offering the highest commissions, potentially disregarding the suitability of those plans. The complaint further details allegations of incentivizing sales based on these commissions, establishing dedicated sales teams for specific high-commission plans, and instances of allegedly refusing to sell plans from insurers with lower commission structures. Discrimination against MA beneficiaries with disabilities is also alleged. Hagens Berman's Investigation The confluence of a weaker-than-anticipated earnings report and ongoing legal entanglements has amplified anxieties surrounding SelectQuote's financial stability and operational integrity. According to Reed Kathrein, the Hagens Berman partner spearheading an inquiry into the company, 'The recent earnings figures underscore our existing concerns about SelectQuote's alleged steering tactics in light of the DOJ's allegations.' If you invested in SelectQuote and have substantial losses, or have knowledge that may assist the firm's investigation, submit your losses now » If you'd like more information and answers to frequently asked questions about the SelectQuote investigation, read more » Whistleblowers: Persons with non-public information regarding SelectQuote should consider their options to help in the investigation or take advantage of the SEC Whistleblower program. Under the new program, whistleblowers who provide original information may receive rewards totaling up to 30 percent of any successful recovery made by the SEC. For more information, call Reed Kathrein at 844-916-0895 or email [email protected]. # # # About Hagens Berman Hagens Berman is a global plaintiffs' rights complex litigation firm focusing on corporate accountability. The firm is home to a robust practice and represents investors as well as whistleblowers, workers, consumers and others in cases achieving real results for those harmed by corporate negligence and other wrongdoings. Hagens Berman's team has secured more than $2.9 billion in this area of law. More about the firm and its successes can be found at Follow the firm for updates and news at @ClassActionLaw. Contact: Reed Kathrein, 844-916-0895 SOURCE: Hagens Berman Sobol Shapiro LLP press release
Reuters
3 days ago
- Business
- Reuters
Takeaways for healthcare companies on Justice Department's Corporate Whistleblower Awards Pilot Program
June 12, 2025 - The risk healthcare companies face when whistleblowers come forward to report civil and criminal offenses to the government has never been greater. The federal False Claims Act (FCA) has long provided for the prospect of significant financial payouts to relators who report fraud or kickback violations in connection with federal programs. Last August, the Department of Justice (DOJ) announced the Corporate Whistleblower Awards Pilot Program (CWA), which created new financial incentives for whistleblowers to report information about corporate crime in certain priority areas, including healthcare matters not covered by the FCA. And through separate incentive programs offering the prospect of leniency (rather than money) announced in 2024, DOJ's Criminal Division and multiple U.S. Attorneys' Offices seek to attract reports of healthcare crimes (and other offenses). On May 12, 2025, as part of a sweeping announcement regarding white-collar enforcement priorities and policy changes, Matthew Galeotti, Head of DOJ's Criminal Division — which created and administers the CWA — made clear the Trump administration is not only keeping the CWA, but expanding its scope, adding offenses about which DOJ seeks to attract tips. Significantly, through a memorandum released the same day, Galeotti directed prosecutors to be "laser-focused on the most urgent criminal threats to the country," including healthcare fraud. In remarks on June 10, 2025, at the Global Anti-Corruption, Ethics & Compliance Conference in New York City, Galeotti noted that since expanding the CWA, DOJ has received new tips in all program areas. This article explores the genesis of the CWA, the types of healthcare cases the government is seeking to incentivize whistleblowers to report, recent revisions to the CWA, and practical takeaways for healthcare companies given: (1) heightened whistleblower risks; (2) DOJ's high prioritization of healthcare offenses; and (3) the Criminal Division's revised Corporate Enforcement and Voluntary Self-Disclosure Policy (CEP), unveiled alongside the CWA updates. Genesis and purpose of the CWA The CWA's purpose is for DOJ to attract information about crimes that would otherwise go unprosecuted, or not be identified as rapidly. DOJ modeled the CWA after the Securities and Exchange Commission's successful whistleblower program. Yet, other regulators' whistleblower programs have limited jurisdiction, and qui tam actions are only available for fraud against the government. Accordingly, DOJ launched the CWA to help "fill the gaps in this patchwork" of whistleblower programs, as stated by former Deputy Attorney General Lisa Monaco on Aug. 1, 2024, in a speech in Washington, D.C., displayed on the DOJ website. DOJ's choice to expand the CWA early in the new administration is consistent with bipartisan support for whistleblower programs. Unlike certain whistleblower programs, there are no congressional appropriations for the CWA. However, the CWA is authorized by statute: Under 28 U.S.C. § 524(c)(1)(C), the U.S. Attorney General, in her discretion, can award payment in return for information leading to civil or criminal forfeiture. The CWA adds a layer of guidance atop that statutory framework, providing whistleblowers with an opportunity to receive a financial award if they (i) report original information (ii) about one of the CWA's enumerated crime types (iii) that enables DOJ to obtain a forfeiture greater than $1 million — and (iv) did not play more than a minimal role in the criminal activity, as defined in U.S.S.G. § 3B1.2 cmt. n.4. The newly revised CWA seeks to attract tips about eight types of violations by corporations, i.e., those involving: (1) financial institutions (including money laundering); (2) foreign corruption; (3) domestic corruption; (4) violations committed by or through companies related to (a) federal health care offenses and related crimes involving health care benefit programs, and (b) fraud against patients, investors, and other non-governmental entities in the health care industry; (5) federal contract and federal program fraud not involving healthcare or illegal health care kickbacks; (6) trade, tariff, and customs fraud; (7) federal immigration law; and (8) sanctions offenses, material support of terrorism, or cartels and transnational criminal organizations. One rationale for the CWA's creation was to put a thumb on the scale in a company's calculus regarding corporate self-disclosure by increasing the probability that DOJ could learn about misconduct from another source. DOJ and other agencies, like the U.S. Department of Health and Human Services, Office of Inspector General, and the U.S. Department of Commerce, heavily promoted policies concerning voluntary self-disclosure by corporations and individuals in recent years, all while extolling the virtues of effective compliance programs. These incentives extend across administrations, and this administration has doubled down by simplifying and increasing rewards for self-disclosure. A criticism of whistleblower rewards has been that they undermine a company's internal reporting mechanisms. Acknowledging this, when the CWA was created, DOJ's Criminal Division issued a temporary amendment to CEP, which allows companies that receive internal reports to still qualify for a declination if they satisfy conditions including reporting to DOJ within 120 days, even if the whistleblower reports to DOJ before the company. This language remains part of the newly revised CEP. Types of healthcare cases DOJ seeks to incentivize Federal healthcare programs have long been a DOJ focus, but fraud directed at private insurance plans has received less scrutiny. The 2024 CWA initially sought information about healthcare fraud schemes in which the overwhelming majority of claims are submitted to private insurance plans, where the majority of the loss was to non-governmental entities, or where the FCA does not reach the conduct. Before the CWA, relators' counsel lacked an incentive to file suits where the volume of alleged private insurance fraud exceeded federal program fraud. Now, the revised CWA seeks such matters as well as cases that do potentially overlap with the federal FCA regime. DOJ is interested in deterring private insurance fraud given market trends and the large portion of Americans who rely on private health insurance coverage. Prosecutions involving private insurance fraud have involved sizable losses. DOJ is also interested in reports of schemes that pose risks to patients or U.S. investors/shareholders, as the FCA does not offer a financial incentive for such reports unless a federal program was defrauded. Federal prosecutors also obtained a new statutory tool relevant to private insurance schemes in 2018: the Eliminating Kickbacks in Recovery Act ("EKRA"). While DOJ has been steadily utilizing EKRA — both to combat addiction treatment fraud and to investigate crimes at laboratories — before the CWA, there was no incentive for whistleblowers to report EKRA schemes. This was a notable asymmetry, as the FCA has yielded millions of dollars in rewards to whistleblowers who reported false claims premised on violations of the Anti-Kickback Statute, which prohibits kickback schemes implicating healthcare providers more broadly but only where items or services are reimbursed by government healthcare programs. Practical takeaways for healthcare company compliance programs As of late 2024, the CWA had attracted more than 250 unique tips. The first award under the CWA will not likely occur for some time. Nonetheless, incentives for whistleblowers are as strong as they've ever been. Healthcare companies should keep the following in mind: First, supporting a "speak up" culture and testing internal reporting mechanisms remains crucial. DOJ's Evaluation of Corporate Compliance Programs continues to emphasize anonymous, confidential reporting systems. Second, the revised CEP may move the needle on the question of whether to self-disclose for some healthcare providers. While it went unremarked upon in Galeotti's speech, unlike in the previous CEP, a disclosure to DOJ will now be considered voluntary as long as a company has no pre-existing obligation to disclose the misconduct to DOJ. Under the old CEP, disclosure would not be voluntary if there was a pre-existing obligation to disclose arising from anywhere, including, for instance, from the Affordable Care Act's 60-day rule. See, e.g., 42 C.F.R. § 422.326(d). The revised CEP also relaxes the definition of "aggravating circumstances" and recidivism such that companies with prior offenses may newly qualify for declinations. Further, the revised CEP offers concrete benefits to companies that miss the mark on other criteria, but attempt to self-report in good faith: shorter-term non-prosecution agreements with reductions of 75% off the applicable Sentencing Guidelines range. There has only been one CEP declination for a healthcare offense to date, awarded to a Medicare Advantage Organization that was investigated for fraudulently overbilling CMS. The previous rarity of CEP declinations in the Medicare context was not necessarily surprising given the prior definition of "voluntary." While the revised CEP is an improvement, healthcare providers considering disclosures to DOJ should consult counsel to undertake a fact-driven assessment of whether the rewards outweigh risks. Third, the CWA has the effect of potentially alerting criminal prosecutors of civil cases earlier than would have otherwise been discovered, as the CWA encourages whistleblowers to over-report misconduct to DOJ even if another program (or the FCA) covers it. Healthcare companies should assume that criminal and civil teams are sharing CWA reports. Fourth, an effective compliance program will not only better position a company to detect and prevent misconduct, but also assist them during negotiations should an investigation arise. Healthcare companies should likewise be mindful of the CWA's inclusion of trade, tariff, foreign bribery and immigration-related violations by corporations.
Reuters
4 days ago
- Business
- Reuters
False Claims Act enforcement expands amid shifting white-collar landscape
June 16, 2025 - Although the current administration has deprioritized white-collar enforcement in some traditionally active areas, False Claims Act ("FCA") activity remains robust — and is poised for expansion. The executive branch has signaled that it will pursue FCA cases in new areas, including diversity, equity and inclusion ("DEI") initiatives, antisemitism on university campuses, transgender issues, and customs and tariffs compliance. These developments signal heightened exposure for a wide range of institutions, from corporations to universities to healthcare providers. Meanwhile, enforcement in traditional FCA strongholds — such as healthcare — continues unabated. Below, we discuss these emerging and continued FCA risks. From Jan. 1 through May 31, 2025, DOJ announced approximately 128 FCA settlements totaling approximately $1.257 billion — a pace consistent with enforcement under the prior administration. DOJ has shown no signs of scaling back pending matters, signaling continued FCA scrutiny across key sectors. Healthcare and Paycheck Protection Program ("PPP") cases remain dominant, representing 90 of the 128 settlements (~70%) and accounting for over $1.04 billion — more than 80% — of the total recoveries to date. The emphasis on healthcare and PPP cases is in line with the prior year, when DOJ collected $1.67 billion from healthcare-related settlements and $250 million from pandemic fraud-related actions. False Claims Act Settlements and Judgments Exceed $2.9B in Fiscal Year 2024, U.S. Dep't of Justice: Office of Public Affairs (Jan. 15, 2025). The importance of whistleblower actions under the FCA's qui tam provisions also remains clear: At least 65% of the settlement value so far in 2025 stems from relator-initiated cases. DOJ has also initiated new healthcare actions. Recently, DOJ filed an FCA suit against three of the country's largest insurers — Aetna, Elevance, and Humana — as well as three major insurance brokers — GoHealth, SelectQuote, and eHealth. Hannah Albarazi, "Aetna And Humana Accused Of Medicare Kickbacks And Bias," Law360 (May 1, 2025). The complaint alleges a years-long scheme by these insurers to provide kickbacks to insurance brokers who in return allegedly funneled seniors into the Medicare plans most profitable for the insurers. Although no Answer has been filed yet, the press has reported that the defendants dispute the allegations and intend to fight the case in court. "Trump's DOJ Accuses Medicare Advantage Insurers of Paying 'Kickbacks' for Primo Customers," KFF Health News (May 19, 2025). This case was initially brought by a relator under the FCA's qui tam provisions, but DOJ intervened and unsealed it on May 1, 2025. This case is a strong signal that the healthcare sector will remain a central focus of the new administration's FCA enforcement priorities. Recent DOJ pronouncements indicate that FCA liability is expanding into areas not previously associated with fraud enforcement, including DEI initiatives, antisemitism, transgender issues, and tariffs. Just one day into the new administration, the President signed an Executive Order which instructed all executive agencies to enforce civil rights laws and eliminate what it characterized as unlawful DEI programs. Exec. Order No. 14173, 90 Fed. Reg. 8633 (Jan. 31, 2025). Building on that Executive Order, the Attorney General issued a February 2025 memorandum reaffirming DOJ's position that many DEI initiatives violate federal civil rights laws. Memorandum re: Ending Illegal DEI and DEIA Discrimination and Preferences, Office of the Attorney General (Feb. 5, 2025). The memorandum directed the DOJ Civil Rights Division to pursue investigations and penalties against private companies and academic institutions that receive federal funds whose DEI practices unlawfully "discriminate, exclude, or divide individuals based on race or sex." Id. at 1. And on May 19, 2025, the U.S. Deputy Attorney General issued a memorandum (the "Memo") announcing a Civil Rights Fraud Initiative (the "Initiative"). Memorandum re: Civil Rights Fraud Initiative, Office of the Deputy Attorney General (Feb. 5, 2025). The Memo instructs DOJ to pursue FCA actions against any federal contractor or federal funds recipient that "knowingly violates federal civil rights laws." The Memo calls for coordination with other federal and state agencies and sets out potential enforcement targets, including: •Federal funding recipients or federal contractors that falsely certify compliance with civil rights laws while maintaining DEI programs that allegedly assign benefits or burdens based on race, ethnicity, or national origin. •Federally funded universities that allegedly permit antisemitism on campuses. Critically, the Memo also "strongly encourages" private plaintiffs to file qui tam suits under the FCA — effectively deputizing employees, students, and other insiders as enforcement partners. Id. at 2. The Memo highlights the potential for private individuals to share in any monetary recovery that results from these cases. Indeed, under the FCA, whistleblowers can receive up to 30% of any monetary recovery, which — under the treble damages provision — could total several times the value of the federal contract or grant at issue. For federal contractors, universities and other federal funds recipients, the enforcement implications are significant. Organizations found in violation of the FCA can face treble damages and per-claim penalties ranging from $14,000 to $28,000, in addition to reputational harm and follow-on litigation. Adjustments for Inflation to Civil Monetary Penalties, 15 C.F.R. § 6.3 (2025). DOJ has already launched investigations under this new Initiative. According to recent reports, it is probing Harvard University's admissions practices for potential FCA violations tied to the Supreme Court's Students for Fair Admissions decision, which struck down race-conscious admissions. Michael C. Bender and Michael S. Schmidt, "Trump Administration Escalates Harvard Feud With New Justice Dept. Investigation," N.Y. Times (May 15, 2025). On Jan. 28, 2025, President Trump issued an Executive Order directing federal and state agencies to take steps to restrict medical treatments related to gender transition for minors. Exec. Order No. 14173, 90 Fed. Reg. 8771 (Feb. 3, 2025). The Executive Order targets the use of puberty blockers, hormone therapies, and transgender surgeries for individuals under the age of 19. On April 22, 2025, the Attorney General signaled that DOJ would use the FCA to enforce the principles of the Executive Order in a memorandum titled "Preventing the Mutilation of American Children." Memorandum re: Preventing the Mutilation of American Children, Office of the Attorney General (Apr. 22, 2025). This memorandum "direct[s] the Civil Division's Fraud Section to pursue investigations under the False Claims Act of false claims submitted to federal health care programs for any noncovered services related to radical gender experimentation." Id. at 4. According to the memorandum, "[f]alsely billing the government for the chemical or surgical mutilation of a child is a violation of the False Claims Act and is subject to treble damages and severe penalties." Id. at 4. Notably, the memorandum encourages whistleblowers to come forward under the FCA's qui tam provisions, again highlighting DOJ's interest in leveraging insider information to identify and pursue potential violations. Id. at 4. Finally, the May 19 Memo also signals DOJ's new focus on transgender issues. The Memo notes that federally funded universities could violate the FCA if they maintain policies that "allow men to intrude into women's bathrooms," or "require women to compete against men in athletic competitions." Memorandum re: Civil Rights Fraud Initiative, Office of the Deputy Attorney General (Feb. 5, 2025). In line with the Trump administration's announcement of a sweeping new tariff regime in April 2025, DOJ officials have emphasized that FCA enforcement will play a key role in customs and trade compliance. In a February speech, Michael Granston, Deputy Assistant Attorney General in DOJ's Commercial Litigation Branch, called the FCA a "powerful tool" to address tariff evasion and foreign trade violations. Daniel Wilson, "DOJ Official Flags 'Aggressive' FCA Approach Under Trump," Law360 (Feb. 20, 2025). As tariffs rise and enforcement intensifies, the risk of FCA exposure in customs-related matters is expected to grow significantly. With these developments, federal fund recipients should expect an uptick in both DOJ scrutiny and qui tam activity related to civil rights compliance, transgender issues, and tariff enforcement. Given these new and increasing risks, federal contractors and recipients of federal funds should consider reviewing and, as needed, revising and enhancing their policies and procedures, including with respect to internal whistleblower channels for reporting violations, to ensure continued compliance with the FCA and federal civil rights laws. With respect to transgender care, healthcare providers and organizations that offer transgender care to minors should assess their billing practices and coverage determinations for compliance with DOJ's new FCA enforcement posture. Particular attention should be paid to documentation, coding, and any federal program reimbursements tied to treatments for individuals under the age of 19. Finally, businesses involved in importing goods should proactively assess their compliance programs, including tariff classification and documentation procedures, to mitigate the risk of FCA scrutiny. With DOJ increasingly linking trade enforcement to FCA liability, importers should also prepare for heightened oversight and the possibility of whistleblower-driven investigations. The opinions expressed are those of the authors and do not necessarily reflect the views of their employer, clients, or any of their respective affiliates. Debevoise associates Hirsa Amin and Nathaniel Quigley contributed to this article.
Yahoo
6 days ago
- Business
- Yahoo
CT-based Otis Elevator agrees to pay $616K to resolve False Claims Act allegation in Tennessee
Otis Elevator Company has agreed to pay more than $500,000 to resolve allegations tied to the False Claims Act. The settlement was announced Friday by the U.S. Attorney's Office for the Eastern District of Tennessee. Under the terms of the settlement, Otis will pay the government $616,987, federal officials said. Otis, which is headquartered in Farmington, agreed to the settlement to resolve allegations related to invoices for preventive maintenance services submitted to the Tennessee Valley Authority 'that were not rendered pursuant to the terms of a contract,' federal authorities said. 'A contractor, like Otis, has an obligation to submit invoices and seek reimbursement solely for work and services that have been performed as claimed,' U.S. Attorney Francis M. Hamilton III for the Eastern District of Tennessee said in a statement. 'This settlement with Otis demonstrates that the United States Attorney's Office and federal partners like TVA's Office of the Inspector General are using all tools available to address fraud, waste and abuse and protect public funds.' The investigation focused on an August 2017 contract between Otis and TVA. Authorities contend that the contract required Otis to provide turnkey modernization and specified monthly preventative maintenance services related to certain elevators in the TVA Knoxville Office Complex. Federal officials said 'certain civil claims' against Otis arose from its performance of the contract. 'Specifically, the United States contended that Otis submitted false claims for payment to TVA for preventive maintenance services that were not rendered,' the U.S. Attorney's Office wrote in a statement The settlement was the result of a coordinated effort between the U.S. Attorney's Office and the TVA Office of the Inspector General – Office of Investigations (TVA-OIG). 'The TVA Office of the Inspector General is committed to identifying and investigating instances where vendors fail to fulfill contractual obligations as well as false claims and overpayments that negatively impact ratepayers throughout the Tennessee Valley. We would like to thank the United States Attorney's Office for their dedicated support of such efforts,' Assistant Inspector General, Investigations D. Eric Beals of the Tennessee Valley Authority Office of Inspector General, said in a statement.
