DOJ and HHS Relaunch False Claims Act Working Group to Target Healthcare Fraud
The U.S. Department of Justice (DOJ) and the Department of Health and Human Services (HHS) have announced the reestablishment of the False Claims Act (FCA) Working Group to strengthen enforcement efforts against fraud, waste, and abuse in federal healthcare programs. This initiative, initially formed in December 2020, underscores the continued priority of FCA as a critical tool in addressing health care fraud under the current administration. The FCA Working Group brings together leadership from various HHS offices and DOJ divisions to target key enforcement areas including fraudulent claims, overbilling, and complex compliance violations in health care and life sciences sectors.
The renewed focus signals proactive federal action amid large recoveries from FCA settlements and judgments, which yield billions annually for federal programs. Despite a brief dip in healthcare-related FCA cases recently, enforcement efforts are projected to intensify, building on record numbers filed during the previous administration. The group will prioritize assessing potential FCA violations based on materiality and intent, aligning with DOJ's strategic priorities that now also emphasize enforcing antidiscrimination laws and investigating claims for noncovered services within federal health programs.
A notable aspect of the FCA Working Group's approach is its integration of whistleblower reports as a vital component for identifying fraud and abuse. The joint task force aims to foster cooperation by encouraging voluntary disclosures, remediation efforts, and maintaining strong compliance frameworks within healthcare organizations. The group also monitors evolving legal interpretations of the FCA’s qui tam provisions, which currently face constitutional scrutiny but remain active enforcement instruments.
Recent federal enforcement actions, including the largest healthcare fraud takedown to date coordinated by DOJ and HHS’s Office of Inspector General, reinforce the government’s commitment to rigorous FCA application. Compliance strategies recommended for healthcare companies emphasize robust internal audits, responsive corrective measures, and legal counsel knowledgeable in FCA matters. Additionally, building a culture of transparency and accountability within organizations is highlighted as a critical defense against potential whistleblower litigation.
Overall, healthcare and life sciences entities, particularly those contracting with federal programs, must stay vigilant towards both traditional and emerging FCA risks. This includes risks related to overbilling, medically unnecessary services, and civil rights infringements under federal programs. Continuous monitoring of DOJ policies, HHS enforcement signals, and fostering a compliance-oriented corporate environment are essential steps to mitigate enforcement risks and ensure regulatory adherence moving forward.