False Eligibility Application For Grant May Violate FCA
Client Alert | 1 min read | 11.09.05
In a ruling that could expand the exposure of grantees to False Claims Act liability, the Seventh Circuit in United States ex rel. Main v. Oakland City University (Oct. 20, 2005) held that a relator stated an FCA claim based upon a private university's allegedly false representation, made on a "phase one" application to establish institutional eligibility for federal financial aid, that it would comply with laws prohibiting payment of incentive fees to recruiters for enrolling students. Rejecting the argument that the "phase one" application does not by itself seek any payment, the court reasoned that a false "phase one" eligibility application could be actionable as a "false record or statement" under the FCA because it supports subsequent "phase two" requests for specific loans and grants.
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
