False Claims and Qui Tam Enforcement

The False Claims Act is typically immune to the changing tides of the White House, however administrative policy priorities, staffing changes, and the pendulum swing have made waves in the FCA landscape over the last two years. In this session, we’ll look back at the impact of the first half of Trump 2.0 and look ahead to what the next two years will bring.

This session will discuss:

• Identifying administrative priorities and comparing statements to activity
• Assessing the enforcement actions promised and taken under this administration
• Considering the impact of the midterm election on the next two years of FCA enforcement activity
• Analyzing how a downswing in FCPA activity has led to an increase in FCA enforcement
• Considering the reach of the Administrative False Claims Act Expansion following the Small Business Association’s 2026 final ruling

As new administrative priorities reach the litigation stage, and new technologies enter the fold, it’s critical to break down the nuts and bolts of FCA litigation to understand where the contours of novel questions meet the rules of the road.

This session will dive deep into the latest litigation questions surrounding materiality, causation, pleading standards, and scienter to uncover tools and strategies for litigation on the horizon.

Topics of discussion include

• Understanding materiality in the context of novel or recently revisited enforcement priorities
  • Civil Rights Fraud Initiative and DEI
  • Wolf Amendment
  • Federal Grant recipients including higher education and research institutions
• Considering the Supreme Court reaffirming of the materiality test as outlined in United States v. Kousisis
• Revisiting Escobar in the context of Kousisis to ask how to prove materiality
• Conceptualizing what the law should require to prove materiality
• Unpacking the rulings in U.S. ex rel. Gallian v. AmerisourceBergen Corporation and the new pleading standard enunciated therein
• Looking to the courts for clarity on the line between scienter and falsity
  • United States ex. rel. Schutte v. SuperValu Inc
• Asking the question, “how can a company be knowingly doing something wrong if it’s permissive elsewhere?
• Addressing the question of scienter when it comes to AI-made decisions

The Trump administration has promised to crack down on DEI practices since early in its tenure; we’re now seeing the first cases come to light.

This session will break down the key elements of the IBM resolution and Deloitte settlement to identify the similarities and differences between each case, and what this means for corporate planning going forward.

Tariffs just may be the #1 political buzzword of the last few years. With international trade under a microscope, and tariffs changing frequently, importers who have never considered False Claims Act liability are suddenly finding themselves in the FCA crosshairs.

This session will break down the key elements that can lead to customs and tariff FCA scrutiny, and provide insights on how to avoid liability.

Topics of discussion include

• Examining the impact and activity of the DOJ-DHS joint Trade Fraud Task Force
• Identifying the common themes, drivers, and foci of customs and tariff FCA enforcement
  • Country of origin
  • Double invoicing
  • Misclassification
  • Misstatements of value
• Pre-empting violations when importing critical equipment or materials from their only source

Despite rising trends in FCA enforcement outside of the healthcare realm, healthcare and related industries remain the primary target for FCA enforcement.

This session will break down the latest enforcement areas in the healthcare space, identifying continuing, emerging, and growing trends.

Topics of discussion include

• Identifying current healthcare enforcement areas of concern
  • Testing
  • Skin substitutes
  • Home healthcare fraud
  • Skilled nursing facilities
  • Managed care
• Assessing the current state of the Anti-Kickback Statute
• Implementing tools for guardrails and governance of AI usage in the healthcare space
• Examining the heightening focus on Affordable Care Act fraud
• Revisiting enforcement activity related to Part C Medicare Advantage
• Analyzing Commonwealth of Massachusetts v. UnitedHealthcare Insurance Company for insights into Senior Care Option (SCO) and Affordable Care Option (ACO) enforcement activity
• Forecasting the next year of healthcare enforcement activity

With the sheer volume of dollars that the government puts out for government contracting sitting somewhere in the trillions, it’s surprising that qui tam activity is relatively low. This session will break down the reasons behind low numbers of cases in the defense, procurement, and GovGon space while identifying the potential triggers that can lead to enforcement down the line.

Topics of discussion include:

• Determining the challenges rooted in Investigating fraud in procurement and defense
• Building ways to meet materiality standards and other litigation elements under the FCA
• Responses to defenses that pose more of a challenge
• Identifying common areas of fraud in the procurement, defense, and GovCon space
  • Cybersecurity
  • Pricing and mischarging
  • PPP and federal loans
  • Tariff and customs fraud
  • Meeting contract specification requirements
• Breaking down the proposed rules under the Revolutionary FAR Overhaul (RFO)
• Brainstorming potential triggering events born out of administrative statements that could snowball into an FCA nightmare
  • E.g. administrative prohibitions on paying dividends to shareholders could mean limits on CEO pay leading to prohibitions of stock buybacks, which in turn would lead to delinquency in meeting contract deadlines

With organizational and personnel changes at Main Justice, the states have continued to take up an increased number of cases in the healthcare space. Some State Medicaid Fraud Control Units (MFCUs) in particular have heavily upped their case load, recovering almost $2 million in 2025, while others have been denied funding altogether.

This session will survey the current state of MFCUs, demystifying their role in enforcement and offering tools, tips, and tricks for working together.

Topics of discussion include:

• Assessing the current status of MFCUs across the United States
• Exploring the partnership between state MFCUs and Medicare Fraud Strike Force Teams
  • Office of Inspector General
  • Department of Justice
  • Offices of the United States Attorneys
  • Federal Bureau of Investigation
  • Local law enforcement
• Understanding MFCUs’ roles in fulfilling Executive Order 14395 “Establishing the Task Force to Eliminate Fraud”
• Identifying tools, tips, and best practices for successful collaboration with state MFCUs

DOJ has been requiring cybersecurity controls in their government contracts for years. As data hacks became a much more common threat, the agency cracked down with their 2021 Civil Cyber-Fraud Initiative.

With many cases still under seal, the danger of lackadaisical implementation of cybersecurity requirements has not been very clear, but that’s all changing. In 2025, they recovered $52 million in FCA cybersecurity actions alone, and that number is expected to rise exponentially in 2026.

• Understanding mandatory cybersecurity standards set by the National Institute of Standards and Technology (NIST)
  • NIST SP 800-171 controls
• Acknowledging the particularity involved in cybersecurity for those contracting with the Department of Defense for purposes of national security
  • Cybersecurity Maturity Model Certification (CMMC)
• Dissecting cybersecurity settlements for critical lessons surrounding cybersecurity and AI compliance
  • Illumina Inc.
  • Georgia Tech Research Corporation
  • Aero Turbine Inc.
• Analyzing the proposed rules under the Revolutionary FAR Overhaul (RFO) surrounding AI procurement and the 72-hour cybersecurity incident reporting mandate
• Ensuring proper due diligence when undergoing M&A activity and contracting with third parties

Year over year, the DOJ breaks records with FCA settlements in the healthcare space, and this year is no exception.

With treble damages on the table, and potential costs so high, how do you find the right amount to settle?

This session will walk through the necessary steps to dial in on a settlement amount that all sides can agree upon, and the quirks that are particular to healthcare.

Topics of discussion include:

• Revisiting the current state of Rule 9(b) and what it means for healthcare settlement calculations
• Determining when to settle, and when to try your luck in court
• Comparing damages calculations to settlement amounts in recent settlements
  • Omincare/CVS DOJ settlement

Recoveries in procurement fraud are growing, and though they still don’t quite reach the level of healthcare the financial risk is real, and contractors are still in danger of treble damages should the case reach litigation.

This session will break down the particularities in putting together settlement amounts and avoiding major payouts for defense and procurement government contractors.

This session will discuss:

• Revisiting the current state of Rule 9(b) and what it means for calculating procurement and defense settlement amounts
• Understanding the legacy of U.S. ex rel. Hendrix v. J-M Manufacturing Co for calculating procurement damages