In a 217-page complaint filed on May 1, 2025, the U.S. Department of Justice (DOJ) brought civil claims under the False Claims Act against major health insurers—Aetna, Elevance Health (previously known as Anthem) and Humana—alleging they paid hundreds of millions of dollars in kickbacks to some of the country’s largest insurance brokers to steer Medicare beneficiaries into their Medicare Advantage plans. Medicare Advantage—a $450 billion program through which private insurers deliver federal health benefits to seniors and people with disabilities—is a critical revenue driver for the nation’s largest health insurers. Read the full Alert on the Duane Morris website.
First Circuit Embraces More Restrictive View of FCA Kickback Enforcement Provision
The United States Court of Appeals for the First Circuit’s opinion in United States v. Regeneron Pharmaceuticals, Inc. has sharpened the circuit split for demonstrating the effect of a kickback on healthcare decisions under the False Claims Act (FCA). The Regeneron court held that an FCA claim based on an alleged violation of the Anti-Kickback Statute (AKS) requires demonstrating that an alleged unlawful kickback was the “but-for” cause of a submitted claim. Read the full Alert on the Duane Morris website.