In an effort to intensify their efforts against health care fraud, the U.S. Department of Justice (“DOJ”) and the Department of Health and Human Services (“HHS”) announced on July 2, 2025, the creation of a DOJ-HHS False Claims Act (“FCA”) Working Group (the “Working Group”). While DOJ and HHS have a long history of collaborative work under the FCA, this initiative signals a heightened and coordinated focus on investigating and prosecuting health care fraud. The Working Group aims to streamline investigations, identify new leads and leverage HHS data and program integrity tools to detect fraud that might otherwise go unnoticed, thereby increasing FCA exposure for health care providers.
Continued Efforts
In FY 2024, health care fraud continued to be a major target of FCA enforcement. Health care-related settlements and judgments accounted for over $1.67 billion of the total $2.9 billion in FCA recoveries. Enforcement efforts targeted a wide range of providers, including hospitals, skilled nursing facilities, pharmacies, pharmaceutical companies and laboratories. The creation of the Working Group signals follow-through on the White-Collar Enforcement Plan issued by the DOJ’s Criminal Division on May 12, 2025, which cited health care fraud as a high-impact area.
Working Group Membership
The Working Group will include members from HHS Office of General Counsel, the Centers for Medicare & Medicaid Services (“CMS”) Center for Program Integrity, the Office of Counsel to the HHS Office of Inspector General (“HHS-OIG”) and DOJ’s Civil Division.
Priority Enforcement Areas
The Working Group has identified the following areas as top priorities in their efforts to prevent health care fraud through the FCA:
- Medicare Advantage fraud, including risk adjustment fraud or inflating risk scores;
- Arrangements involving drug and device pricing, including medically unnecessary prescriptions or billing for non-FDA-approved uses;
- Barriers to patient access to care, including network adequacy requirements;
- Kickbacks related to health care products and services, with a particular emphasis on drugs, devices and durable medical equipment;
- Materially defective medical devices impacting patient safety, including making misleading statements about a device’s safety or effectiveness; and
- Manipulation of Electronic Health Records systems to inflate claims or support unnecessary services.
The Working Group encourages both whistleblowers and health care companies to identify and report FCA violations, especially within these priority enforcement areas.
Practical Takeaways
- The Working Group demonstrates a continued commitment to investigating and taking enforcement action regarding provider non-compliance.
- Providers should take proactive steps to review and bolster their compliance programs, with a particular emphasis on auditing, monitoring and implementing corrective actions, especially as they relate to the identified priority areas.
- The Working Group’s emphasis on encouraging whistleblowers to report potential violations highlights the need for providers to have clear channels for employees to report concerns without fear of retaliation.
Hall Render will continue to track and provide updates on this Working Group’s activity. If you have questions or would like more information about this topic, please contact:
- Katherine Kuchan at (414) 721-0479 or kkuchan@hallrender.com;
- Ritu Kaur Cooper at (232) 370-9584 or rcooper@hallrender.com;
- Kaitlin Nucci at (248) 457-7838 or knucci@hallrender.com; or
- Your primary Hall Render contact.
Special thanks to Summer Associate David Yanda for his assistance in the preparation of this article.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot give legal advice outside of an attorney-client relationship.
