In a further sign that healthcare fraud enforcement remains a top Department of Justice (“DOJ”) priority, on April 30, 2026, the National Fraud Enforcement Division ( “Fraud Division”) announced the launch of the West Coast Health Care Fraud Strike Force (“West Coast Strike Force”). While the Fraud Division was itself newly created, this latest news is of a piece with the traditional model and enforcement approach of DOJ’s dedicated health care fraud team going back to 2007. Nationally, since its inception, the HCF Strike Force program has been responsible for the prosecution of over 6,200 defendants who collectively billed federal health care programs and private insurers more than $45 billion.
https://fcablog.sidley.com/wp-content/uploads/sites/5/2022/08/sidleyLogo-e1643922598198.png00Kristin Graham Koehlerhttps://fcablog.sidley.com/wp-content/uploads/sites/5/2022/08/sidleyLogo-e1643922598198.pngKristin Graham Koehler2026-05-06 15:09:322026-05-06 15:09:32DOJ’s National Fraud Enforcement Division Launches West Coast Health Care Fraud Strike Force
A recent decision from the Eastern District of Pennsylvania provides an important procedural win for defendants and a reminder that the False Claims Act’s seal provision is not intended to provide indefinite confidentiality. In United States ex rel. Compton v. HCR ManorCare, Inc., the court ordered the unsealing of close to 50 ex parte motions that the United States filed to extend the statutory 60-day seal period to close to ten years, while it investigated the complaints and decided whether to intervene.
In a closely watched mandamus proceeding, the Texas Fifteenth Court of Appeals denied mandamus relief to a defendant pharmaceutical company in a qui tam case brought under the Texas Healthcare Program Fraud Prevention Act (the “Act”). While the majority declined to reach the merits of the defendant’s constitutional challenges to the Act—holding that mandamus relief was premature because an adequate remedy exists through post-trial appeal—the dissent authored by Chief Justice Brister delivers a sweeping critique that could have substantial implications for future qui tam litigation in Texas. Most notably, the dissent concludes that (1) the relator lacks standing under the Texas Constitution; and (2) the Act’s qui tam provisions, as applied in cases in which Texas has not intervened, violate the separation of powers requirement under the Texas Constitution.
https://fcablog.sidley.com/wp-content/uploads/sites/5/2022/08/sidleyLogo-e1643922598198.png00Kwaku A. Akowuahhttps://fcablog.sidley.com/wp-content/uploads/sites/5/2022/08/sidleyLogo-e1643922598198.pngKwaku A. Akowuah2026-05-04 09:04:082026-05-04 09:52:04Texas Qui Tam Under Fire: Texas Appellate Dissent Raises Major Constitutional Doubts
As we previously reported here, record numbers of cases are being filed by “whistleblowers” under the FCA—approximately 1,300 qui tam suits last year alone. This morning, Brenna Jenny, the Deputy Assistant Attorney General, Civil Division, Commercial Litigation Branch, announced at a conference that much of the surge in qui tam complaints is being driven not by insiders, but by entities set up to mine publicly available government data sets. That is putting pressure on DOJ’s Civil Fraud Section, tasked with investigating qui tam allegations. In order to address the challenge, Jenny announced the Fraud Oversight through Careful Use of Statistics (FOCUS) initiative, which presents an opportunity for data miners to meet with the Civil Fraud Section to explain the reliability of their data. Though not a pre-filing requirement, data miners who choose to participate “should be prepared to explain what differentiates their approach, how they validate their findings, and why their methodology provides a reliable basis for identifying high-quality, actionable False Claims Act matters.” DOJ’s announcement of the FOCUS initiative makes clear that “the Department will prioritize working with data miners that have demonstrated an investment in pre-filing diligence and commitment to analytical rigor, familiarity with program rules, and legally sufficient allegations.” It will be interesting to see whether the Department increases its exercise of authority to dismiss qui tam suits brought by data miners that cannot so demonstrate.
https://fcablog.sidley.com/wp-content/uploads/sites/5/2022/08/sidleyLogo-e1643922598198.png00Kristin Graham Koehlerhttps://fcablog.sidley.com/wp-content/uploads/sites/5/2022/08/sidleyLogo-e1643922598198.pngKristin Graham Koehler2026-04-30 11:17:292026-04-30 11:44:20DOJ Announces FOCUS Initiative to Work with Data Miners Filing Qui Tams
The U.S. Court of Appeals for the Ninth Circuit issued a decision that reenforces the high bar for an award of attorneys’ fees above the lodestar amount in an FCA case. In United States ex rel. Thrower v. Academy Mortgage Corp., No. 24-4103 (9th Cir. Apr. 6, 2026), the Ninth Circuit reversed and remanded an order awarding more than $8.5M in attorneys’ fees in a case that resulted in a substantial settlement after the relator defeated not only the defendant’s motion to dismiss but also a rare motion to dismiss that the Government filed on its own behalf. The decision confirms that an award of attorneys’ fees over the lodestar amount must be supported by specific evidence, even if the relator obtained an exceptional result.
Last week, the Department of Justice (“DOJ”) announced a more than $17 million settlement with IBM to resolve allegations that the company violated the FCA by defying “anti-discrimination requirements as set forth in Title VII.” This is the first settlement to emerge from the DOJ’s Civil Rights Fraud Initiative, on which we previously reported here and here. Unveiled May 19, 2025, the Initiative aims to use the FCA to pursue claims against federal funding recipients that allegedly violate civil rights laws via “racist preferences, mandates . . . and activities”—including where those violations occurred in the context of companies operating diversity, equity, and inclusion programs. Notably, as we reported here, the Deputy Assistant Attorney General of DOJ’s Commercial Litigation Branch, Brenna Jenny, used an address at the Federal Bar Association’s Qui Tam Conference last February to stress DOJ’s commitment to enforcement premised on such discrimination.
https://fcablog.sidley.com/wp-content/uploads/sites/5/2022/08/sidleyLogo-e1643922598198.png00Kristin Graham Koehlerhttps://fcablog.sidley.com/wp-content/uploads/sites/5/2022/08/sidleyLogo-e1643922598198.pngKristin Graham Koehler2026-04-13 09:39:472026-04-13 09:39:47DOJ Announces First FCA Settlement Resolving Title VII Discrimination Allegations
A recent decision from the U.S. Court of Appeals for the Ninth Circuit significantly reshapes the intersection of the False Claims Act (FCA) and the 340B Drug Pricing Program (340B Program). In United States ex rel. Adventist Health System of West v. AbbVie, No. 24-2180 (9th Cir. Mar. 17, 2026), the court reversed the dismissal of a qui tam action alleging that pharmaceutical companies inflated drug prices in violation of the 340B statutory ceiling, holding that such claims may proceed under the FCA notwithstanding the absence of a private right of action under the 340B statute. The decision marks a notable departure from a district court ruling—and from prior assumptions about the scope of the Supreme Court’s decision Astra USA, Inc. v. Santa Clara County, 563 U.S. 110 (2011)—and opens the door to increased FCA exposure tied to 340B Program pricing practices.
A divided panel of the Fourth Circuit reversed the dismissal of a qui tam FCA suit alleging that the defendant pharmaceutical company underpaid Medicaid rebates by misreporting “best price” under the Medicaid Drug Rebate Statute. The decision marks the Fourth Circuit’s first application of the subjective scienter standard articulated by the Supreme Court in United States ex rel. Schutte v. SuperValu Inc., and underscores the difficulty defendants may face in securing dismissal at the pleading stage on the scienter element.
DOJ’s National Fraud Enforcement Division Launches West Coast Health Care Fraud Strike Force
In a further sign that healthcare fraud enforcement remains a top Department of Justice (“DOJ”) priority, on April 30, 2026, the National Fraud Enforcement Division ( “Fraud Division”) announced the launch of the West Coast Health Care Fraud Strike Force (“West Coast Strike Force”). While the Fraud Division was itself newly created, this latest news is of a piece with the traditional model and enforcement approach of DOJ’s dedicated health care fraud team going back to 2007. Nationally, since its inception, the HCF Strike Force program has been responsible for the prosecution of over 6,200 defendants who collectively billed federal health care programs and private insurers more than $45 billion.
(more…)
Kristin Graham Koehler
Washington, D.C.
kkoehler@sidley.com
Jaime L.M. Jones
Chicago
jaime.jones@sidley.com
Lisa H. Miller
Washington, D.C.
lisa.miller@sidley.com
Dave Anderson
San Francisco
dlanderson@sidley.com
Sheila A.G. Armbrust
San Francisco
sarmbrust@sidley.com
Douglas A. Axel
Los Angeles
daxel@sidley.com
Kevin R. Rubino
San Francisco
krubino@sidley.com
Mallory W. Edel
New York
medel@sidley.com
E.D. Pa. Rejects Indefinite Sealing of FCA Extension Materials, Emphasizing Narrow Purpose of Seal
A recent decision from the Eastern District of Pennsylvania provides an important procedural win for defendants and a reminder that the False Claims Act’s seal provision is not intended to provide indefinite confidentiality. In United States ex rel. Compton v. HCR ManorCare, Inc., the court ordered the unsealing of close to 50 ex parte motions that the United States filed to extend the statutory 60-day seal period to close to ten years, while it investigated the complaints and decided whether to intervene.
(more…)
Jaime L.M. Jones
Chicago
jaime.jones@sidley.com
Meredith Greene Jalali
Chicago
meredith.jalali@sidley.com
Texas Qui Tam Under Fire: Texas Appellate Dissent Raises Major Constitutional Doubts
In a closely watched mandamus proceeding, the Texas Fifteenth Court of Appeals denied mandamus relief to a defendant pharmaceutical company in a qui tam case brought under the Texas Healthcare Program Fraud Prevention Act (the “Act”). While the majority declined to reach the merits of the defendant’s constitutional challenges to the Act—holding that mandamus relief was premature because an adequate remedy exists through post-trial appeal—the dissent authored by Chief Justice Brister delivers a sweeping critique that could have substantial implications for future qui tam litigation in Texas. Most notably, the dissent concludes that (1) the relator lacks standing under the Texas Constitution; and (2) the Act’s qui tam provisions, as applied in cases in which Texas has not intervened, violate the separation of powers requirement under the Texas Constitution.
(more…)
Kwaku A. Akowuah
Washington, D.C.
kakowuah@sidley.com
Jaime L.M. Jones
Chicago
jaime.jones@sidley.com
Kenneth G. Coffin
Dallas
kenneth.coffin@sidley.com
Matt Bergs
Chicago
mbergs@sidley.com
DOJ Announces FOCUS Initiative to Work with Data Miners Filing Qui Tams
As we previously reported here, record numbers of cases are being filed by “whistleblowers” under the FCA—approximately 1,300 qui tam suits last year alone. This morning, Brenna Jenny, the Deputy Assistant Attorney General, Civil Division, Commercial Litigation Branch, announced at a conference that much of the surge in qui tam complaints is being driven not by insiders, but by entities set up to mine publicly available government data sets. That is putting pressure on DOJ’s Civil Fraud Section, tasked with investigating qui tam allegations. In order to address the challenge, Jenny announced the Fraud Oversight through Careful Use of Statistics (FOCUS) initiative, which presents an opportunity for data miners to meet with the Civil Fraud Section to explain the reliability of their data. Though not a pre-filing requirement, data miners who choose to participate “should be prepared to explain what differentiates their approach, how they validate their findings, and why their methodology provides a reliable basis for identifying high-quality, actionable False Claims Act matters.” DOJ’s announcement of the FOCUS initiative makes clear that “the Department will prioritize working with data miners that have demonstrated an investment in pre-filing diligence and commitment to analytical rigor, familiarity with program rules, and legally sufficient allegations.” It will be interesting to see whether the Department increases its exercise of authority to dismiss qui tam suits brought by data miners that cannot so demonstrate.
(more…)
Kristin Graham Koehler
Washington, D.C.
kkoehler@sidley.com
Jaime L.M. Jones
Chicago
jaime.jones@sidley.com
Matt Bergs
Chicago
mbergs@sidley.com
Joseph R. LoCascio
Chicago
joseph.locascio@sidley.com
Anna M. Schmitt
Chicago
anna.schmitt@sidley.com
Ninth Circuit Rejects $8.5M Award Of Attorneys’ Fees to FCA Whistleblower
The U.S. Court of Appeals for the Ninth Circuit issued a decision that reenforces the high bar for an award of attorneys’ fees above the lodestar amount in an FCA case. In United States ex rel. Thrower v. Academy Mortgage Corp., No. 24-4103 (9th Cir. Apr. 6, 2026), the Ninth Circuit reversed and remanded an order awarding more than $8.5M in attorneys’ fees in a case that resulted in a substantial settlement after the relator defeated not only the defendant’s motion to dismiss but also a rare motion to dismiss that the Government filed on its own behalf. The decision confirms that an award of attorneys’ fees over the lodestar amount must be supported by specific evidence, even if the relator obtained an exceptional result.
(more…)
Jaime L.M. Jones
Chicago
jaime.jones@sidley.com
Naomi A. Igra
San Francisco
naomi.igra@sidley.com
DOJ Announces First FCA Settlement Resolving Title VII Discrimination Allegations
Last week, the Department of Justice (“DOJ”) announced a more than $17 million settlement with IBM to resolve allegations that the company violated the FCA by defying “anti-discrimination requirements as set forth in Title VII.” This is the first settlement to emerge from the DOJ’s Civil Rights Fraud Initiative, on which we previously reported here and here. Unveiled May 19, 2025, the Initiative aims to use the FCA to pursue claims against federal funding recipients that allegedly violate civil rights laws via “racist preferences, mandates . . . and activities”—including where those violations occurred in the context of companies operating diversity, equity, and inclusion programs. Notably, as we reported here, the Deputy Assistant Attorney General of DOJ’s Commercial Litigation Branch, Brenna Jenny, used an address at the Federal Bar Association’s Qui Tam Conference last February to stress DOJ’s commitment to enforcement premised on such discrimination.
(more…)
Kristin Graham Koehler
Washington, D.C.
kkoehler@sidley.com
Jaime L.M. Jones
Chicago
jaime.jones@sidley.com
H. Boyd Greene IV
Washington, D.C.
bgreene@sidley.com
Joseph R. LoCascio
Chicago
joseph.locascio@sidley.com
Ninth Circuit Opens Door to FCA Liability for Alleged 340B Overcharges
A recent decision from the U.S. Court of Appeals for the Ninth Circuit significantly reshapes the intersection of the False Claims Act (FCA) and the 340B Drug Pricing Program (340B Program). In United States ex rel. Adventist Health System of West v. AbbVie, No. 24-2180 (9th Cir. Mar. 17, 2026), the court reversed the dismissal of a qui tam action alleging that pharmaceutical companies inflated drug prices in violation of the 340B statutory ceiling, holding that such claims may proceed under the FCA notwithstanding the absence of a private right of action under the 340B statute. The decision marks a notable departure from a district court ruling—and from prior assumptions about the scope of the Supreme Court’s decision Astra USA, Inc. v. Santa Clara County, 563 U.S. 110 (2011)—and opens the door to increased FCA exposure tied to 340B Program pricing practices.
(more…)
Jaime L.M. Jones
Chicago
jaime.jones@sidley.com
Naomi A. Igra
San Francisco
naomi.igra@sidley.com
Matt Bergs
Chicago
mbergs@sidley.com
Hannah Zobair
Chicago
hannah.zobair@sidley.com
Fourth Circuit Highlights Tougher Path to Dismissal of FCA Cases Post-SuperValu
A divided panel of the Fourth Circuit reversed the dismissal of a qui tam FCA suit alleging that the defendant pharmaceutical company underpaid Medicaid rebates by misreporting “best price” under the Medicaid Drug Rebate Statute. The decision marks the Fourth Circuit’s first application of the subjective scienter standard articulated by the Supreme Court in United States ex rel. Schutte v. SuperValu Inc., and underscores the difficulty defendants may face in securing dismissal at the pleading stage on the scienter element.
(more…)
Jaime L.M. Jones
Chicago
jaime.jones@sidley.com
Scott D. Stein
Chicago
sstein@sidley.com
Matt Bergs
Chicago
mbergs@sidley.com
Anna M. Schmitt
Chicago
anna.schmitt@sidley.com
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