False Estimates: A Misguided Notion Under The FCA
Client Alert | less than 1 min read | 07.22.05
Just as Russian officials have sought to hold weather forecasters liable for bad predictions, some qui tam relators and federal agencies have sought to stretch the False Claims Act (FCA) to impose liability for false estimates. In his article "The Strange Notion of Estimates as Fraud: Will Weather Predictions Be Next Under the False Claims Act?" published in The Procurement Lawyer (Summer 2005 http://www.crowell.com/pdf/BodenheimerSUM05.pdf), David Z. Bodenheimer explains that these "false estimate" allegations cannot be squared with common law rules that generally exclude opinions and predictions as a basis for fraud, FCA requirements that demand objective (not subjective) proof of falsity, and basic federal procurement standards that recognize the subjectivity inherent in estimating future costs.
Insights
Client Alert | 2 min read | 03.27.26
CMS Releases PY 2020 RADV Audit Methods and Instructions: Key Takeaways for Health Plans
On March 20, 2026, the Centers for Medicare and Medicaid Services (CMS) released new guidance outlining the agency’s audit methods and instructions for Medicare Advantage (MA) plans subject to upcoming risk adjustment data validation (RADV) audits for payment year (PY) 2020. In addition to providing necessary context for MA plans selected for auditing, this resource clarifies CMS’s methodological and procedural expectations. While the high-level takeaways are recapped below for convenience, we strongly recommend that MA organizations selected for PY 2020 audits closely review the guidance to understand what may be involved — or required — during the agency’s review.
Client Alert | 4 min read | 03.25.26
NAIC Intensifies AI Regulatory Focus: What Health Insurance Payors Need to Know
Client Alert | 11 min read | 03.25.26
White House National AI Policy Framework Calls for Preempting State Laws, Protecting Children
Client Alert | 3 min read | 03.24.26
California Considering A Massive Expansion of Its Antitrust Laws
