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Fourth Circuit Interprets Corporate Knowledge And Materiality Under FCA

Client Alert | 1 min read | 01.08.04

In United States ex rel. Harrison v. Westinghouse Savannah River Co. (Dec. 19, 2003), the Fourth Circuit upheld a civil penalty of $195,000 ($7500 times 26 invoices) because the false cert "negatively affected the integrity of the bidding process," although zero actual damages were proven. The court held that (a) the False Claims Act's "knowledge" element was satisfied when one employee of the corporate defendant had knowledge of the facts making the corporation's certification false, even though there was no evidence that the same employee knew that the cert was required or even that it had been submitted; and (b) the false cert (that no organizational conflict of interest (OCI) existed in connection with a subcontract award) was "material" because it would have "had a natural tendency to influence" the government's decision to fund the subcontract "if it had known the full details" at the time of award, even though the government in fact concluded that no OCI existed when it subsequently learned of the issue and continued to pay for the subcontract work thereafter.

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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....