Edward A. Baker

In September 2023, Ed published an auditing tip in the e-newsletter of the National Alliance of Medical Auditing Specialists (NAMAS) on the U.S. Supreme Court’s 2022 decision in U.S., et al, ex rel. Schutte, et al. v. SuperValu, Inc., et al. In December 2023, he published an additional auditing tip for NAMAS on Cigna’s 2023 $172 million False Claims Act settlement with the DOJ.

Prior to serving as an AUSA, Mr. Baker was an Assistant Attorney General for the State of Vermont, where he was the Director of the Medicaid Fraud and Residential Abuse Unit. In that capacity, he was responsible for all aspects of the management and operation of Vermont’s Medicaid Fraud Control Unit, charged with investigating and prosecuting, both civilly and criminally, fraud and patient abuse/neglect within Vermont’s Medicaid program. He was a member of the litigation table team for thirty-six states in a qui tam lawsuit against Wyeth and Pfizer for Medicaid pharmaceutical “best price” violations that ultimately resulted in a $785 million settlement. He also laid the groundwork for the enactment of the Vermont False Claims Act and held leadership positions within the National Association of Medicaid Fraud Control Units.

Prior to his eight years of government service, Mr. Baker was in private practice, first, as a litigator in the Government Enforcement Defense practice group of a large Boston law firm, then at a national plaintiff’s firm where he litigated antitrust and securities class actions.

Mr. Baker has a J.D. cum laude from the University of Wisconsin-Madison. During law school, he was a Managing Editor of the Wisconsin Law Review, and the founder of a student organization devoted to exploring the intersection of legal theory and practice. He was elected Class Orator at graduation, and was recognized for his outstanding service to the law school, and for scholarship, character, and contribution to the greater community. In addition to his law degree, Mr. Baker has an M.A. in Religion from Yale University, and an M.A. in Philosophy from Tufts University. He graduated from Dartmouth College with a B.A. in Philosophy modified with Biology.

Mr. Baker is admitted to practice in the District of Columbia, Massachusetts, New Hampshire, and Vermont; as well as in the U.S. District Courts for the Eastern District of New York, Eastern District of California, Eastern District of Wisconsin, District of Massachusetts, and the District of Vermont.

Presentations

•Managed Care Fraud and Enforcement, ABA Qui Tam & Civil False Claims and Healthcare Fraud Institute, May 28, 2026
•Managed Care Enforcement and Compliance; Whistleblowers, HCCA San Juan Regional Healthcare Compliance Conference, May 4-5, 2026
•Compliance Conundrum: How to Assess the Risk of a False Claims Act Lawsuit?, HCCA Compliance Institute 2026, April 17, 2026
•Fundamentals of Medicaid Managed Care, TAF Coalition Webinar, May 13, 2025
•Bad, Better, Best Practices: Avoiding FCA Liability for False or Invalid HCC Diagnoses from HRAs; Your Risk of False Claims Act Violations When Filing Medicare Advantage Claims, AAPC HealthCon, April 6-9, 2025
•Risk Adjustment and Coding: What’s Fraud Got to Do with It?, AAPC HealthCon, April 14-17, 2024
•The False Claims Act, 15th Annual NAMAS Auditing & Compliance Conference, December 7-8, 2023
•FCA and Liability for Risk Adjustment, HCCA Annual Healthcare Enforcement Compliance Conference, November 5, 2023
•The Future is Now: Managed Care Enforcement Trends and Compliance Best Practices, ABA Health Law Section 4th Annual National Managed Care Institute, October 12, 2023
•AI and the False Claims Act, Federal Bar Association Qui Tam Section Roundtable, October 11, 2023
•Before the Subpoena Arrives: Proactive Strategies for Payers and Providers to Get Ahead of Medicare Advantage Compliance Problems, BCBS 2023 Law, Audit, Compliance & Ethics Conference, August 6-9, 2023
•The Essential Role of Coders and Auditors in Risk Adjustment Litigation, AAPC HealthCon, May 24, 2023
•Risk Adjustment Panel, AAPC HealthCon, May 22, 2023
•A Moving Target: Key Litigation and Regulatory Developments in Medicare Advantage Risk Adjustment, AHLA Health Plan Law and Compliance Institute, May 19, 2023
•Risk Adjustment Litigation and Risk Areas for Plans, Providers, and Others, RISE CompliancePalooza 2022, Oct. 11, 2022
•The FCA and the Controlled Substances Act, FBA Qui Tam Section Webinar, Sept. 28, 2022
•The Current State of Risk Adjustment Litigation and Risk Areas for MA Plans, Vendors, and Downstream Entities, RISE West 2022, Sept. 1, 2022
•FCA Medicaid Fraud Litigation: Defense, DOJ, and Relator Perspectives, NAMFCU Global Team Leader Symposium, Aug. 3, 2022
•Updates to the MA Risk Adjustment Toolkit, AHLA Educational Webinar, July 11, 2022
•Risk Adjustment FCA Cases: Government Overreach or Reasonable Oversight?, AHLA Annual Meeting 2022, June 29, 2022
•An Update on FCA Legal Developments and Trends, NAMFCU Training Conference, Mar. 30, 2022
•Fraud and Abuse: Tracking the Latest in Medicare and Medicaid Related Enforcement Actions and What it Means for Payors Going Forward, ACI Advanced Managed Care Forum, Mar. 31, 2022
•Real Life Risk Adjustment Compliance Failures: How to Avoid Turning a ‘Glitch’ Into a ‘Gotcha’, RISE National 2022, Mar. 9, 2022

Honors & Awards

•Selected for inclusion by peers in The Best Lawyers in America in the field of “Qui Tam Law,” 2022-2026

Publications

•DOJ Ramps Up Enforcement Against Covid-19 Fraud,” Constantine Cannon Whistleblower Insider, April 2022
•“Jury finds Teva Pharmaceuticals Liable for Contributing to Opioid-Related Deaths in New York State,” Constantine Cannon Whistleblower Insider, Jan. 2022
•“WBOTY Nomination: Daniel Ellsberg and The GroundTruth Project,” Constantine Cannon Whistleblower Insider, Dec. 2021
•“Pharmacy Owner Convicted in $174 Million Telehealth Fraud that Targeted Consumers and PBMs,” Constantine Cannon Whistleblower Insider, Dec. 2021
•“Next Up: Infrastructure Oversight Week,” Constantine Cannon Whistleblower Insider, Nov. 2021
•Op-Ed, “On the Anniversary of the Gettysburg Address, We Should Follow Lincoln’s Lead,” Patriot News - Lancaster PA, Nov. 21, 2021
•“Whistleblower Reveals Facebook’s Lies: Will the SEC or Congress Act to Curtail Threats to Democracy and Teens from Social Media?,” Constantine Cannon Whistleblower Insider, Oct. 2021
•“United States Reaches a ‘Tipping Point’ in Managed Care Enforcement,” Constantine Cannon Whistleblower Insider, July 2021
•“FDA’s Approval of Alzheimer’s Drug Highlights Need for Whistleblowers,” Constantine Cannon Whistleblower Insider, July 2021
•Co-Author, AHLA Medicare Advantage Risk Adjustment Litigation “Toolkit,” AHLA PPMC Practice Group, July 2021 (updated Mar. 2022, Nov. 2022)

In the News

•May 27, 2026
Lieff Cabraser Attorneys to Speak at ABA Qui Tam & Civil False Claims and Healthcare Fraud Institute 2026
•May 1, 2026
Edward Baker to Speak at Upcoming HCCA San Juan Regional Healthcare Compliance Conference
•August 21, 2025
36 Lieff Cabraser Lawyers Named to 2026 Best Lawyers Listings
•April 7, 2025
Ed Baker to Speak on False Claims Act Cases at HealthCon 2025 in Orlando, Florida on April 8th and 9th
•January 6, 2025
Lieff Cabraser Announces New Partners

Past Employment Positions

•Constantine Cannon, LLP, Of Counsel
•U.S. Department of Justice, Assistant U.S. Attorney, Eastern District of California
•Office of the Vermont Attorney General, Director, Medicaid Fraud & Residential Abuse Unit
•Boies, Schiller & Flexner, LLP, Associate