JEJohn E. Kelly

1. Article · Sep 9, 2026 · John E. Kelly

   The Villages Health System $541.5 Million Settlement: A New Frontier in Medicare Advantage Risk Adjustment Enforcement (opens the original)

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   Under the Medicare Advantage (MA) program — also known as Medicare Part C — Medicare beneficiaries may elect to receive their Medicare benefits through private health plans offered by MAOs rather than traditional Medicare. The Centers for Medicare & Medicaid Services (CMS) pays MAOs a monthly capitated amount for each enrolled beneficiary. CMS adjusts these payments based on “risk” factors affecting expected healthcare costs: in general, MAOs receive higher payments for sicker beneficiaries and

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2. Article · Sep 3, 2026 · John E. Kelly

   Back to Status Quo- Eleventh Circuit Upholds FCA’s Qui Tam Provisions Against Appointments Clause Challenge (opens the original)

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   On Sept. 1, 2026, the Eleventh Circuit held in United States ex rel. Zafirov v. Fla. Med. Assocs., LLC, that the FCA’s qui tam provisions do not violate the Appointments Clause of Article II of the U.S. Constitution. No. 24-13581, 2026 WL 2581886 (11th Cir. Sept. 1, 2026). The Eleventh Circuit specifically held that qui tam relators are not “Officers” subject to the Appointments Clause because they do not occupy a “continuing position” established by law. In so holding, the Eleventh Circuit reve

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