On July 2, 2025, the U.S. Departments of Justice (DOJ) and Health and Human Services (HHS) announced the reinstitution of the DOJ-HHS False Claims Act Working Group. Originally established in December 2020 during the first Trump administration, the Working Group seeks to leverage the federal False Claims Act (FCA), "one of the government's most effective and successful tools," to combat healthcare fraud and abuse that "depletes taxpayer funds, corrodes public health and safety, and undermines the integrity of the federal healthcare system." The re-launch comes a year after the DOJ reported approximately $2.9 billion in settlements and judgments under the FCA, with $1.67 billion (57 percent) related to matters involving the healthcare industry, a figure that does not include related recoveries for state Medicaid programs.

The Working Group will be jointly led by the HHS General Counsel, Chief Counsel to HHS-Office of Inspector General (OIG), and the Deputy Assistant Attorney General (DAAG) of the DOJ Commercial Litigation Branch. Membership also includes leadership from the Centers for Medicare & Medicaid Services (CMS) Center for Program Integrity and various U.S. Attorneys' Offices.

In addition to the DOJ's Civil Division Enforcement Priorities announced last month, the Working Group plans to prioritize the following enforcement areas:

• Medicare Advantage
• Drug, device, or biologics pricing, including arrangements for discounts, rebates, service fees, and formulary placement and price reporting
• Barriers to patient access to care, including violations of network adequacy requirements
• Kickbacks related to drugs, medical devices, durable medical equipment, and other products paid for by federal healthcare programs
• Materially defective medical devices that impact patient safety
• Manipulation of Electronic Health Records systems to drive inappropriate utilization of Medicare covered products and services

The Working Group intends to expedite ongoing investigations and identify new leads in these priority areas by leveraging cross-agency collaboration, HHS data and HHS-OIG report findings, and whistleblower complaints. The announcement also notes that the Working Group will discuss when to implement payment suspensions and when to move to dismiss qui tam complaints under 31 U.S.C. section 3730(c)(2)(A).

The DOJ's announcement encourages whistleblowers to report FCA violations in the key enforcement areas identified above, suggesting that qui tam cases will continue to be a central means of enforcing the FCA in this area.

Although the DOJ has signaled its intention to broaden FCA enforcement beyond the traditional areas of Medicare and Medicaid fraud, the announcement of the revamped Working Group is a strong signal that authorities intend to continue to aggressively target fraud in the healthcare industry.  

For more information, please contact:

Bradley E. Markano, bmarkano@milchev.com, 202-626-6061

Lauren E. Briggerman, lbriggerman@milchev.com, 202-626-5966

Connor W. Farrell, cfarrell@milchev.com, 202-626-5925

or any attorney in our False Claims Act Litigation group.

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