On July 2, 2025, the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) announced the reinvigoration of their False Claims Act (FCA) enforcement efforts through the formation of a joint FCA Working Group. The announcement signals renewed federal attention to health care fraud enforcement as part of the current administration’s expansive enforcement strategies under the FCA.
Working Group Agenda
The agencies confirmed that the working group will:
- Target traditional areas such as Medicare Advantage fraud, kickbacks, and drug and device pricing practices.
- Expand into less traditional areas that have more recently drawn FCA enforcement scrutiny, such as violations of network adequacy requirements, defective medical devices and manipulation of electronic health records systems to boost Medicare billing.
- Focus on the division-wide DOJ civil enforcement priorities announced in June 2025, which could involve further focus on the provision of gender-related care.
Enforcement Approach
Consistent with these priorities, the working group will seek to maximize cross-agency collaboration, improve referral mechanisms from HHS to DOJ to proactively develop new leads and leverage enhanced data mining to identify potential FCA violations. DOJ and HHS have also indicated that the group will examine when payment suspensions or qui tam dismissals are appropriate, reflecting an effort to streamline FCA investigations and litigation.
Industry Impact
As with other government-facing industries subject to the administration’s FCA-related priorities, companies in the health care space should expect intensified civil enforcement risk under the FCA in the near term. At a minimum, the development of the FCA Working Group highlights the continuing importance for companies to maintain robust compliance systems, carefully monitor arrangements implicating federal health care funds and remain ready to respond to government inquiries. Companies should anticipate closer federal coordination in both civil and potential criminal enforcement around fraud and abuse in health care programs.
See the Executive Briefing publication
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