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.
Insights
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 | 2 min read | 02.03.26
Sedona Model Jury Instructions for DTSA: A Step Forward—But Questions Remain
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
