Spotlight on November 2025 FWA

Why This Topic Matters

These cases highlight current enforcement priorities and the types of billing, documentation, referral, and compliance issues that can lead to major settlements, criminal convictions, and corporate integrity obligations. Readers can use the article to stay current on risk areas that affect coding compliance, audit preparation, and program integrity.

Article Sections

1. Diagnostic Laboratory Agrees to Pay More Than $9 Million to Settle Alleged False Claims Act Violations

   Summarizes allegations involving laboratory claims, Medicare billing, referral arrangements, and program integrity concerns.

2. VRA Enterprises Agrees to Pay Over $17 Million for Allegedly Billing Medicare for Over-the-Counter COVID-19 Tests That Were Not Provided to Beneficiaries, Or That Were Sent to Beneficiaries Months After Being Billed to Medicare

   Covers alleged Medicare billing issues tied to a COVID-19 test demonstration initiative and pharmacy distribution practices.

3. Tri-Cities Urgent Care Clinic Agrees to Pay $2.8 Million to Resolve Claims of Overbilling for Diagnostic Tests

   Reviews allegations involving diagnostic testing claims, panel billing, and Medicaid and Medicare reimbursement concerns.

4. CVS Pharmacy Inc. Pays $18.2 Million to Resolve Alleged False Claims Act Violations

   Addresses allegations involving prescription reimbursement, documentation requirements, and state Medicaid program oversight.

5. Founder/CEO and Clinical President of Digital Health Company Convicted in $100M Adderall Distribution and Healthcare Fraud Scheme

   Summarizes a criminal case involving controlled substances, online prescribing practices, insurance-related fraud, and obstruction allegations.

6. Vohra Wound Physicians and Its Owner Agree to Pay $45M to Settle Fraud Allegations of Overbilling for Wound Care Services

   Covers allegations involving wound care billing, Medicare claims, and post-settlement compliance oversight measures.