US Departments Form False Claims Act Working Group to Increase Anti-Fraud Efforts
TL/DR –
The US Departments of Justice and Health and Human Services (DOJ-HHS) have formed a new False Claims Act Working Group to increase anti-fraud enforcement efforts in the healthcare industry. The Working Group will focus on combating waste, fraud, and abuse in government spending with likely increased reliance on data analytics to identify potential enforcement targets. Healthcare companies are advised to remain vigilant and assess their internal policies to ensure compliance with federal and state laws that govern healthcare delivery and billing.
US Justice and Health Departments Announce New Anti-fraud Initiative
The US Departments of Justice (DOJ) and Health and Human Services (HHS) recently formed the False Claims Act Working Group (FCA Working Group) on July 2, 2025. This move signifies an intensified effort to combat healthcare fraud and aligns with the administration’s stance against wastage, fraud, and abuse in government spending.
The Working Group flag denotes an impending increase in anti-fraud activities, largely instrumentalized by data analytics for identifying potential False Claims Act enforcement targets. It is also indicative of an expected surge in qui tam complaints. Consequently, healthcare companies are encouraged to uphold strict adherence to federal and state laws that govern healthcare delivery and billing.
Working Group’s Structure and Leadership
The FCA Working Group comprises officials from various divisions within the HHS and DOJ. The inclusion of these members highlights the importance placed on direct input on potential fraud issues from HHS and CMS program operators and counsels. The Working Group will be co-headed by Acting HHS General Counsel Sean R. Keveney, Acting Chief Counsel to HHS-OIG Susan Edwards, and Deputy Assistant Attorney General of the Commercial Litigation Branch Brenna E. Jenny.
Working Group’s Enforcement Priorities
The working group will focus on potential FCA violations related to:
- Medicare Advantage
- Drug, device or biologics pricing
- Impediments to patient access to care
- Kickbacks related to drugs, medical devices, durable medical equipment
- Materially defective medical devices that impact patient safety
- Manipulation of Electronic Health Records systems
The group intends to enhance cross-agency collaboration and use enhanced data mining to expedite investigations and uncover new leads.
Continued Focus on Healthcare Fraud
In its previous fiscal year (2024), the DOJ recovered $2.9 billion through the FCA, of which $1.68 billion came from healthcare fraud cases. In addition, DOJ has recently reaffirmed its commitment to fighting healthcare fraud through the White-Collar Enforcement Plan, outlining key areas of focus for prosecutors.
DOJ is not only focusing on civil FCA cases but is also intensifying efforts to prosecute criminal cases involving federal healthcare program fraud. DOJ recently charged 324 defendants in a large-scale healthcare fraud operation.
Implications for Healthcare Companies
The creation of the Working Group serves as a warning to healthcare companies of heightened scrutiny and increased qui tam complaints. Companies are encouraged to routinely review their compliance and anti-fraud policies and monitor their internal data to identify and address potential outlier cases before the government’s intervention.
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