By Matthew Macklin, Managing Attorney, Stratagem Law Group. When a Medicare Advantage recoupment dispute must go through Medicare appeals, and when it need not. Key takeaways 42 U.S.C. § 405(h) channels claims that “arise under” the Medicare Act into Medicare appeals. The rule was written for parties seeking benefits, not for the targets of a plan’s collection demand. A dispute is not channeled merely because it Read More

By Matthew Macklin, Managing Attorney, Stratagem Law Group. A False Claims Act compliance lesson from DOJ’s January 2026 ophthalmology settlement. Key takeaways In January 2026, DOJ announced that five Florida ophthalmology practices agreed to pay nearly $6 million to resolve False Claims Act allegations tied to trans-cranial Doppler ultrasounds billed to Medicare and Medicaid. The claims were allegations Read More