DOJ and HHS Launch Joint Working Group to Boost False Claims Act Enforcement in Healthcare
On July 2, 2025, the U.S. Department of Justice (DOJ) and the Department of Health and Human Services (HHS) jointly announced the formation of a False Claims Act (FCA) Working Group aimed at strengthening enforcement against healthcare fraud. This initiative reflects a continued governmental focus on combating fraud in healthcare programs through enhanced investigatory and enforcement actions. The Working Group has identified six priority areas for expedited investigation, including increased data mining practices to detect fraudulent activities sooner.
A key aspect of the Working Group's approach will be the expanded use of HHS's payment suspension authority in cases where credible allegations of fraud arise. This authority allows CMS to temporarily halt payments to providers under investigation based on various sources such as hotline tips, claims data analytics, and audit findings. Monitoring the Working Group's impact on payment suspension rates and criteria will be significant for healthcare program participants.
Further, the Working Group is set to refine criteria for dismissing qui tam complaints—whistleblower lawsuits filed under the FCA—by assessing the viability of novel legal theories early in the investigative process. This shift aims to streamline investigations and reduce prolonged inquiries into claims lacking substantial legal merit. Factors beyond case merits, such as duplication of government investigations or national security implications, may influence dismissal decisions.
Monthly meetings will guide the Working Group’s ongoing efforts, providing a forum for discussing enforcement priorities and procedural enhancements. This initiative builds on prior DOJ enforcement memoranda and signals heightened scrutiny of FCA actions, affecting providers, insurers, and compliance professionals in the healthcare industry. Legal experts anticipate this will result in more focused and efficient enforcement activity, with broader implications for regulatory compliance strategies.
Law firms with expertise in government investigations, particularly those with experience in FCA litigation, are closely monitoring the Working Group to assist clients navigating this evolving enforcement landscape. The establishment of this group underscores an ongoing commitment by federal agencies to enhance oversight and accountability within healthcare programs through leveraging data analytics and targeted enforcement policies.