In recent weeks, the Justice Department has issued new charging guidelines and announced enforcement actions that reflect the priorities of the current administration. Targeting perceived health care fraud, particularly concerning Medicare and Medicaid, remains a priority of the administration.[1] At the same time, DOJ continues to invite self-reporting by corporations as a mechanism to avoid criminal liability.
Health Care Fraud Takedown Shows Focus on Alleged Medicaid and Medicare Fraud is Alive and Well
In stark contrast to its recent resistance to policing corporate misconduct in foreign corruption and bribery spaces, DOJ has signaled a focus on the False Claims Act (FCA) and health care fraud to punish misconduct viewed as fraud on government programs. On June 30, 2025, the DOJ announced what it referred to as an “unprecedented” “national health care fraud takedown” with a cumulative “$14.6 billion in intended loss.” The enforcement actions, announced as one overarching “2025 National Health Care Fraud Takedown,” consist of civil, criminal, and administrative enforcement nationwide. DOJ announced criminal health care fraud charges against a total of 324 defendants, across 50 U.S. Attorneys Offices and 12 State Attorneys General. DOJ’s press release also announced civil charges against 20 defendants and settlements against 106 defendants. The Centers for Medicare and Medicaid Services (CMS) further announced it had suspended or revoked the privileges of over 200 providers.
The takedown underscores the administration’s emphasis on civil and criminal health care fraud enforcement. It follows President Trump’s June 6, 2025 Executive Order “Eliminating Waste, Fraud, and Abuse in Medicaid.” Between the Executive Order and the way in which this year’s health care fraud takedown was advertised, there’s no doubt that the administration is keen to pursue Medicaid and other health care fraud enforcement.
In announcing the takedown, Matthew R. Galeotti, Acting Assistant Attorney General of the Criminal Division, signaled that the Criminal Division is particularly focused on schemes involving (1) patient harm through medically unnecessary or appropriate treatment; (2) the opioid epidemic; and (3) abuse of Medicare and Medicaid (“stealing money hardworking Americans contribute to pay for the care of their elders and other vulnerable citizens.”). However, the press release also emphasized the prosecution of defendants “charged for their roles in transnational criminal organizations,” echoing the Department’s revised Foreign Corrupt Practices Act (FCPA) guidelines, issued last month.
DOJ and HHS “Reinvigorate” False Claims Act Working Group
Days later, the DOJ Civil Division and the U.S. Department of Health and Human Services (HHS) announced a “False Claims Act Working Group” to refer to DOJ potential violations of the FCA, further indicating that health care fraud will remain a priority. This marks a revival of a similar initiative that was previously announced in December 2020.
The FCA Working Group’s information sharing means that health plans, providers, and vendors should expect more focused civil and administrative investigations, often running concurrently.
Continued Emphasis on Self-Reporting
The DOJ continues to emphasize self-reporting as a mechanism for companies to avoid criminal liability. The announcement of the Working Group again noted its encouragement of whistleblower reports. In June remarks, Galeotti reiterated DOJ’s incentives to individuals and companies to self-report misconduct, boldly asserting that “those companies will receive a declination, not just a ‘presumption.’” His statements refer to DOJ’s previously announced changes to the DOJ’s Self-Disclosure Policy, which indicated that “[p]rosecution of individuals, as well as civil and administrative remedies directed at corporations, are often appropriate to address low-level corporate misconduct and vindicate U.S. interests.”[2] Most recently, DOJ’s Antitrust Division announced a new “Whistleblower Rewards Program.” How these whistleblower programs will actually be implemented remains to be seen.
[1] As we have previously indicated, the Administration remains focused on corporations and institutions of higher education when it comes to alleged discrimination in the form of DEI policies, and we expect will be quick to enforce the Administration’s tariff policies.
[2] See also Criminal Division Corporate Enforcement and Voluntary Self-Disclosure Policy, U.S. Dep’t of Just., Just. Manual § 9-47.120 (Updated 2025), here.
Key Takeaways:
- Companies should be keenly aware of incentives to individuals to report alleged wrongdoing, and as such should evaluate their internal compliance systems, particularly with respect to mechanisms for employees to report misconduct. In light of this incentive, companies must have reporting systems in place, and be prepared to evaluate and respond quickly to inquiries about potential misconduct. Counsel can assist companies with evaluating their compliance systems, and helping to investigate, evaluate, and respond quickly to any such reports.
- Individuals and entities in the health care sector, particularly those who participate in Medicare or Medicaid, should remain vigilant in evaluating and maintaining their compliance programs. Health care organizations should prioritize compliance through robust internal controls, training, and transparency. This includes implementing comprehensive compliance programs, conducting regular audits, and fostering a culture of ethical behavior and open communication.
- Health care providers should focus on accurate record-keeping, proper billing practices, and staying updated on relevant regulations.
- As the FCA Working Group begins its coordination efforts, health care organizations should consult with counsel regarding DOJ policy updates, HHS enforcement trends, and FCA-related guidance to stay ahead of government scrutiny and effectively address concerns raised in whistleblower actions.
