Qui Tam Dismissals Are Spiking: What That Means for FCA Enforcement

Managed Care FCA Enforcement: Risk Adjustment, AI, Kickbacks, and More

Host Jonathan Porter [https://www.huschblackwell.com/professionals/jonathan-porter] welcomes Husch Blackwell partner Tim Ribelin [https://www.huschblackwell.com/professionals/tim-ribelin] to the podcast to discuss False Claims Act enforcement trends in managed care. Fresh off presenting at the American Conference Institute’s managed care conference, Tim shares insights on why 2025 was a watershed year for FCA enforcement. We begin by examining the dramatic spike in FCA enforcement, with record settlements that largely came from healthcare cases. Tim explains why DOJ is building more cases using data analytics, signaling a shift from reactive whistleblower complaints to proactive government investigations. Next, we dive into Medicare Advantage risk adjustment, still the top enforcement priority in the managed care world. Tim walks through common FCA theories, including “one way” or “add-only” chart reviews, aggressive documentation templates, and poorly supervised vendor coding programs. Our conversation shifts to Anti-Kickback Statute scrutiny of broker practices, highlighting a recent case where DOJ alleged brokers steered beneficiaries to plans paying the highest commissions. We then tackle the complex issue of AKS causation and the current circuit split over whether plaintiffs must prove kickbacks were the but-for cause of claims. Tim discusses how AI and analytics are creating new evidentiary risks, examining cases where return-on-investment tracking became evidence of intent to reduce referrals. He provides practical guidance on framing performance metrics to emphasize permitted goals. We close by examining parent and successor liability and how DOJ’s increased use of data analytics is changing the detection landscape. Tim outlines concrete steps organizations should take now, from outlier testing to vendor governance to treating data integrity as a core compliance function. Jonathan Porter | Full Biography [https://www.huschblackwell.com/professionals/jonathan-porter] Jonathan focuses on white collar criminal defense, federal investigations brought under the False Claims Act, and litigation against the government and whistleblowers. He draws on his experience as a former federal prosecutor to guide clients in sensitive and enterprise-threatening litigation. At the Department of Justice, Jonathan earned a reputation as a top white-collar prosecutor and trial lawyer and was a key member of multiple international healthcare fraud takedowns and high-profile financial crime prosecution teams. He serves as a vice chair of the American Health Law Association’s Fraud and Abuse Practice Group and teaches white collar crime as an adjunct professor of law at Mercer University School of Law. Tim Ribelin | Full Biography [https://www.huschblackwell.com/professionals/tim-ribelin] Tim is a commercial litigator who represents business clients in high-stakes, high-dollar cases. He has a special focus on litigating disputes for clients in the healthcare industry. Tim’s litigation practice involves complex business disputes and commercial litigation, ranging from membership/shareholder/partner disputes in closely held companies, business separations, franchisor-franchisee disputes, breach of contract, False Claims Act litigation, healthcare law, insurance disputes related to the payment and processing of healthcare claims, landlord-tenant disputes, business torts, wrongful death actions against companies, and other complex cases. Tim’s prior background and substantial experience in the healthcare space help him advise and guide clients’ litigation matters through a complex regulatory environment. With a knack for problem-solving and a persistent work ethic, Tim thrives on digging deep into the facts of a dispute, assessing the risks, strategies, and other considerations to align the litigation strategy with the clients’ goals. Tim uses this information to determine the most effective path to victory. Clients value his strategic approach, responsiveness, and all-in mindset, often remarking on how thoroughly invested he is in driving their cases forward to a successful resolution.

Relators’ Attorneys’ Fees: Math, Limits, and How to Push Back

Host Jonathan Porter [https://www.huschblackwell.com/professionals/jonathan-porter] welcomes Husch Blackwell partner Kate Ledden [https://www.huschblackwell.com/professionals/kate-ledden] to the podcast to discuss the often-contentious issue of relators’ attorneys’ fees in False Claims Act cases. With fee awards sometimes reaching millions of dollars, this topic has significant financial implications for defendants and raises important questions about what constitutes “reasonable” compensation for qui tam counsel. We begin by exploring the statutory framework for fee-shifting under the False Claims Act. Kate explains when relators are entitled to attorneys’ fees, what it means to “successfully litigate” a case, and why Congress departed from the American Rule to incentivize whistleblowers to bring qui tam actions. She also clarifies that fee awards come on top of the relator’s share of the government’s recovery. Next, we examine how courts determine what constitutes “reasonable” attorneys’ fees using the lodestar method. Kate walks listeners through the two core inputs—reasonable hours and reasonable hourly rates—and explains why courts favor this objective, reviewable approach that approximates what a paying client would pay in comparable hourly-billed litigation. We discuss the unique challenge in False Claims Act cases where complexity can drive the lodestar calculation to enormous levels. Our conversation then turns to the controversial practice of multipliers and enhancements to the lodestar calculation. Kate explains when courts might adjust the lodestar product up or down, why such adjustments are rare, and why courts resist multiplying lodestar based on complexity or risk arguments that relators’ attorneys commonly advance. We examine the recent Ninth Circuit decision in United States ex rel. Thrower v. Academy Mortgage Corp., where a district court awarded $8.5 million in attorneys’ fees (including a 1.75x multiplier) on a $38.5 million settlement. Kate discusses why the Ninth Circuit reversed, finding the district court abused its discretion by enhancing lodestar for an “exceptional result” that was already captured in the reasonable hours and rates calculation. We close with practical guidance for litigating attorneys’ fees issues going forward. Kate outlines concrete strategies for the defense, including how to scrutinize time records, challenge hourly rates, and push back against improper multipliers in light of Thrower’s guidance. Jonathan Porter | Full Biography [https://www.huschblackwell.com/professionals/jonathan-porter] Jonathan focuses on white collar criminal defense, federal investigations brought under the False Claims Act, and litigation against the government and whistleblowers. He draws on his experience as a former federal prosecutor to guide clients in sensitive and enterprise-threatening litigation. At the Department of Justice, Jonathan earned a reputation as a top white-collar prosecutor and trial lawyer and was a key member of multiple international healthcare fraud takedowns and high-profile financial crime prosecution teams. He serves as a vice chair of the American Health Law Association’s Fraud and Abuse Practice Group and teaches white collar crime as an adjunct professor of law at Mercer University School of Law. Kate Ledden | Full Biography [https://www.huschblackwell.com/professionals/kate-ledden] Kate draws on extensive knowledge of both healthcare law and the court system to represent healthcare clients in complex litigation. Kate began her legal career with nearly ten years in federal district courts, where she worked directly with judges on all aspects of trial preparation. She came to know federal procedure backwards and forwards—and she also knows where cases can go wrong. With an inside perspective on how best to succeed in court and at trial, Kate aims to set clients up for the best result from the very beginning of their cases. Kate joined Husch Blackwell out of a desire to return to client advocacy. She’s known as someone who wears her passion on her sleeve, investing deeply in client matters, and has a reputation as an excellent listener and skilled writer who can compellingly convey complicated legal matters. Kate handles high-stakes, complex commercial litigation as well as healthcare regulatory matters, helping clients avoid litigation in the first place. While she has worked with a variety of industries, Kate continues to focus on healthcare and primarily assists healthcare clients, who immediately sense her passion for their field.

Healthcare Compensation and Referrals: Avoiding Compliance Pitfalls in Physician Deals

Host Jonathan Porter [https://www.huschblackwell.com/professionals/jonathan-porter] welcomes Husch Blackwell’s Hal Katz [https://www.huschblackwell.com/professionals/hal-katz] back to the podcast to discuss best practices for structuring physician compensation arrangements and navigating the complex compliance landscape surrounding healthcare referrals. Fresh off presenting at the American Association of Orthopaedic Executives (AAOE) conference, Hal and Jonathan share insights on how healthcare organizations can align financial incentives while staying on the right side of Stark Law and False Claims Act requirements. We begin by examining the spectrum of compliance violations in physician compensation arrangements, from blatant criminal schemes designed to “buy surgeries” through sham consulting contracts to more nuanced cases where well-intentioned financial teams make statements about downstream benefits that later appear in DOJ complaints. Hal discusses a recent DOJ Stark intervention against a Tennessee health system and provides practical guidance on what healthcare executives and compliance officers should and should not say during physician compensation discussions. Next, we turn to the mechanics of how compensation is calculated, drawing lessons from major cases like Tuomey and a Florida hospital settlement where the formula itself included problematic metrics. Hal explains the risks of “black box” compensation arrangements and offers best practices for creating transparent, defensible methodologies that can withstand government scrutiny. Our conversation then shifts to private equity investment in healthcare and the tension between financial realities and compliance requirements. We discuss industry terms like “leakage” and “keeping procedures,” examining how organizations can have honest conversations about referral patterns without crossing legal lines. We close with actionable compliance recommendations. Hal outlines concrete steps that executives, compliance officers, and physician group leaders can take today to strengthen their guardrails and build sustainable, defensible business practices in an increasingly scrutinized industry.  Jonathan Porter | Full Biography [https://www.huschblackwell.com/professionals/jonathan-porter] Jonathan focuses on white collar criminal defense, federal investigations brought under the False Claims Act, and litigation against the government and whistleblowers. He draws on his experience as a former federal prosecutor to guide clients in sensitive and enterprise-threatening litigation. At the Department of Justice, Jonathan earned a reputation as a top white-collar prosecutor and trial lawyer and was a key member of multiple international healthcare fraud takedowns and high-profile financial crime prosecution teams. He serves as a vice chair of the American Health Law Association’s Fraud and Abuse Practice Group and teaches white collar crime as an adjunct professor of law at Mercer University School of Law. Hal Katz | Full Biography [https://www.huschblackwell.com/professionals/hal-katz] Based in Austin, Texas, Hal provides healthcare clients with guidance on corporate, transactional, regulatory, and public policy matters. With over 30 years in practice, he has witnessed firsthand the evolution of the healthcare industry that continues to reshape the business and approaches of healthcare delivery. He represents for-profit, nonprofit, and governmental entities, including medical groups, hospitals, technology companies, behavioral health organizations, private equity funds, academic medical centers, and health plans. Since 2011, Hal has served the American Bar Association’s Health Law Section in a variety of leadership posts— including as its Chair from 2020 to 2021. Additionally, from 2017 to 2018, he chaired the Health Law Section of the State Bar of Texas. Hal also serves on the Board of Trustees of Integral Care and on the Board of the Texas e-Health Alliance, where his work focuses on governance, policy, and the responsible use of technology in healthcare.

$1.6 Billion FCA Judgment on Appeal: What it Means for FCA Enforcement

Host Jonathan Porter [https://www.huschblackwell.com/professionals/jonathan-porter] welcomes Husch Blackwell’s Abe Souza [https://www.huschblackwell.com/professionals/abraham-souza] to the podcast to discuss the recent oral arguments in the Janssen Products case before the Third Circuit Court of Appeals. The case involves a previously discussed staggering $1.6 billion district court judgment [https://www.huschblackwell.com/newsandinsights/false-claims-act-insights-assessing-the-fallout-from-a-thermonuclear-fca-verdict] against the pharmaceutical company based on allegations of improper off-label marketing and reimbursement practices related to HIV medications. We begin by examining the massive penalties at stake and the Excessive Fines Clause concerns raised by Janssen’s appeal. Our discussion explores how courts analyze whether False Claims Act penalties are constitutionally excessive, including the facts courts consider when evaluating whether a multi-billion-dollar judgment violates the Eighth Amendment’s protections against excessive fines. Next, we turn to the substantive False Claims Act issues in the case, focusing on whether off-label marketing can serve as a proper predicate for False Claims Act liability. We discuss how the government connects marketing practices to false claims for reimbursement and examine the legal theories that link promotional activities to allegedly fraudulent billing submissions. Our conversation then shifts to the broader constitutional questions presented in the appeal, including challenges to how the False Claims Act is being applied in pharmaceutical cases. We analyze the arguments raised during oral arguments and what they signal about potential limits on False Claims Act enforcement in the healthcare industry. We close by discussing what the Third Circuit’s eventual decision could mean for pharmaceutical companies, healthcare providers, and False Claims Act enforcement more broadly, particularly with respect to the scope of liability for marketing practices and the constitutional boundaries of FCA penalties.  Jonathan Porter | Full Biography [https://www.huschblackwell.com/professionals/jonathan-porter] Jonathan focuses on white collar criminal defense, federal investigations brought under the False Claims Act, and litigation against the government and whistleblowers. He draws on his experience as a former federal prosecutor to guide clients in sensitive and enterprise-threatening litigation. At the Department of Justice, Jonathan earned a reputation as a top white-collar prosecutor and trial lawyer and was a key member of multiple international healthcare fraud takedowns and high-profile financial crime prosecution teams. He serves as a vice chair of the American Health Law Association’s Fraud and Abuse Practice Group and teaches white collar crime as an adjunct professor of law at Mercer University School of Law. Abe Souza | Full Biography [https://www.huschblackwell.com/professionals/abraham-souza] Abe regularly represents clients embroiled in internal and government investigations, as well as in government enforcement actions. He also represents clients in complex business disputes and commercial litigation matters, including those involving antitrust and class action claims. Prior to joining Husch Blackwell, Abe served for nearly five years as an Assistant U.S. Attorney in the Northern District of Illinois where he worked directly with FBI agents and other investigators and served as a first-chair trial lawyer. He began his legal career as a law clerk for the Honorable Joan Humphrey Lefkow of the U.S. District Court for the Northern District of Illinois.

Qui Tam Dismissals Are Spiking: What That Means for FCA Enforcement

Host Jonathan Porter [https://www.huschblackwell.com/professionals/jonathan-porter] welcomes Husch Blackwell’s Tanner Cook [https://www.huschblackwell.com/professionals/tanner-cook] back to the podcast to discuss the recent spike of DOJ dismissals of improper qui tams under 31 U.S.C. § 3730(c)(2)(A). This episode is a follow-up of our last podcast [https://www.huschblackwell.com/newsandinsights/false-claims-act-insights-doj-announces-record-number-of-qui-tams-and-qui-tam-dismissals], in which Husch Blackwell partner Cormac Conner [https://www.huschblackwell.com/professionals/cormac-connor] discussed how qui tam dismissals increased by around 400% in 2025.  We begin by addressing common misconceptions about how DOJ views its dismissal power, with its focus on process abuse rather than merit disputes. Next, we examine the Granston Memo, which outlines the Department of Justice's protocols for considering dismissal of qui tam actions on various grounds.  Tanner then walks listeners through the details of considerations DOJ uses to assess qui tams for dismissal potential, with examples of the types of instances where DOJ has exercised its (c)(2)(A) dismissal power in the past. We end the discussion by examining what those who defend False Claims Act investigations and qui tams can learn from these recent developments and how to structure dismissal requests to maximize changes of DOJ action. Jonathan Porter | Full Biography [https://www.huschblackwell.com/professionals/jonathan-porter] Jonathan focuses on white collar criminal defense, federal investigations brought under the False Claims Act, and litigation against the government and whistleblowers. He draws on his experience as a former federal prosecutor to guide clients in sensitive and enterprise-threatening litigation. At the Department of Justice, Jonathan earned a reputation as a top white-collar prosecutor and trial lawyer and was a key member of multiple international healthcare fraud takedowns and high-profile financial crime prosecution teams. He serves as a vice chair of the American Health Law Association’s Fraud and Abuse Practice Group and teaches white collar crime as an adjunct professor of law at Mercer University School of Law. Tanner Cook | Full Biography [https://www.huschblackwell.com/professionals/tanner-cook] Based in St. Louis, Tanner is a member of Husch Blackwell’s Commercial Litigation group, focusing on consumer class actions, antitrust litigation, and multidistrict litigation. He frequently takes the lead in drafting critical pretrial briefs, including dispositive motions and evidentiary challenges. In addition to his commercial litigation practice, Tanner regularly assists on white collar defense matters, especially in the False Claims Act context. He has significant experience defending companies from qui tam whistleblower suits at every stage of the litigation process, combining his deep substantive knowledge of the law with creative defense strategies. Tanner served as law clerk at the U.S. District Court, Eastern District of Missouri, for Judge Sarah E. Pitlyk.