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Expert Advice -- Caveat Emptor

Client Alert | 1 min read | 01.15.04

On the heels of a district court rejecting a company's reliance on expert advice in a recent False Claims Act case involving independent research and development charges (U.S. v. Newport News Shipbuilding, Inc., 276 F. Supp. 2d 539 (E.D. Va. 2003)), the Department of Justice has filed a complaint against a major accounting firm alleging that advice provided by that firm to a number of its healthcare clients caused the clients to submit "false claims" in the form of inflated bills for Medicare patients (U.S. v. Ernst & Young, LLP (E.D. Pa., filed Jan. 5, 2004)). Read in conjunction, these cases suggest that reliance on advice from outside accounting experts and other consultants as a defense to FCA charges may not be a safe harbor, particularly in circumstances where there is reason to believe that the expert advice will be perceived as "aggressive" by the government.

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Client Alert | 4 min read | 03.25.26

NAIC Intensifies AI Regulatory Focus: What Health Insurance Payors Need to Know

The National Association of Insurance Commissioners (NAIC) is intensifying its oversight of how insurers use AI — and the pace of regulatory activity shows no signs of slowing. Over the past several months, the NAIC has published a formal Issue Brief staking out its position on federal AI legislation, launched a multistate AI Evaluation Tool pilot aimed at examining insurers’ AI governance programs, and continued to expand adoption of its AI Model Bulletin across state lines. These developments continue a trend towards enhancing regulation; the NAIC adopted AI Principles in 2020 and a Model Bulletin in 2023 clarifying that existing insurance laws apply to AI systems and establishing expectations for governance, documentation, testing, and third-party oversight. That Model Bulletin has now been adopted in approximately 24 states....

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