D.C. Circuit Loosens Public Disclosure Bar While Tightening the Reins on Damages
Client Alert | 1 min read | 05.16.12
In United States ex rel. Davis v. District of Columbia (May 15, 2011), the D.C. Circuit held that recent Supreme Court precedent had abrogated the Circuit's long-standing rule that a relator must provide the government with the information upon which his allegations are based not only before filing an action, but also prior to any public disclosure. The Circuit Court also applied its recent holding in U.S. v. Science Applications Corp., 626 F.3d 1257, that proof of damages requires a showing that, as the result of the alleged fraud, the value of what the government received was less than what it believed it had purchased, finding that, in the matter before it, because there was no allegation that claimed reimbursements were for services not actually received or of inflated value -- only that they lacked documentary support -- "the government got what it paid for and there are no damages."
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Client Alert | 2 min read | 02.03.26
CMS Doubles Down on RADV Audit Changes
On January 27, 2026, the Centers for Medicare and Medicaid Services (CMS) released a Health Plan Management System (HPMS) memo that provided a long-awaited update on how the agency plans to approach previously announced Risk Adjustment Data Validation (RADV) audits for Payment Years (PY) 2020-2024. The memo is the agency’s most comprehensive statement on the subject since September 25, 2025, when the Northern District of Texas vacated the 2023 RADV Final Rule. The memo makes clear that, while CMS has made certain operational adjustments in response to concerns expressed by Medicare Advantage Organizations (MAOs), the agency is largely pressing forward with the accelerated audit strategy announced in May 2025.
Client Alert | 7 min read | 01.30.26
CMS Proposes CY 2027 Growth Rate and Changes to Risk Adjustment for Medicare Parts C and D
Client Alert | 4 min read | 01.30.26
Optimum’s Shot Across the Bow: An Antitrust Challenge to Cooperation Agreements
Client Alert | 9 min read | 01.30.26

