Host Jonathan Porter welcomes Husch Blackwell partner 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.
Host Jonathan Porter welcomes Husch Blackwell partner 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
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
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.