Department of Justice and Health and Human Services Form New Task Force Focused on Enforcing False Claims Act
In a significant move to combat healthcare fraud, the Department of Justice (DOJ) and the Department of Health and Human Services (HHS) announced the formation of a joint DOJ-HHS False Claims Act Working Group (the "Working Group") on July 2, 2025. The Working Group, co-led by Deputy Assistant Attorney General Brenna Jenny of DOJ's Civil Division, is aimed at enhancing enforcement of the False Claims Act (FCA).
Beyond the priority enforcement areas identified in the Civil Division's June 11, 2025 memorandum, which included FCA targets related to diversity, equity, and inclusion (DEI) programs and gender transition care, the Working Group has outlined additional areas of focus for enhanced healthcare fraud enforcement. These areas represent an expanded enforcement focus incorporating fraud in pricing, patient access, improper inducements, and data manipulation.
The Working Group's six priority enforcement areas that go beyond those June 11 targets are:
1. Medicare Advantage: The Working Group will focus on fraudulent activities in Medicare Advantage plans, which provide an alternative way for eligible individuals to receive their Medicare benefits.
2. Drug, device, or biologics pricing: The Working Group will investigate arrangements for discounts, rebates, service fees, formulary placement, and price reporting that may be indicative of fraudulent practices.
3. Barriers to patient access to care: The Working Group will address violations of network adequacy requirements, which ensure that patients have timely access to healthcare providers and services.
4. Kickbacks: The Working Group will examine kickbacks related to drugs, medical devices, durable medical equipment, and other products paid for by federal healthcare programs.
5. Materially defective medical devices: The Working Group will focus on defective medical devices that impact patient safety.
6. Manipulation of electronic health records systems: The Working Group will investigate cases where electronic health records systems are manipulated to drive inappropriate utilization of Medicare-covered products and services.
The Working Group will also explore other additional areas beyond these listed six priorities, with an emphasis on expediting investigations through increased data mining and cooperation across DOJ and HHS entities.
The Working Group's announcement underscores the Administration's continued prioritization of FCA healthcare enforcement. Participants in federal healthcare programs will want to monitor whether the Working Group identifies additional considerations bearing on when HHS should exercise its payment suspension authority, as well as whether there is an uptick in payment suspensions going forward.
The Working Group will meet on a monthly basis, starting in July, to discuss factors for DOJ in determining whether to dismiss qui tam complaints, among other matters. This shift, led by DAAG Jenny, could impact largely unfounded complaints that have resulted in multi-year investigations in the past.
[1] Civil Division, U.S. Department of Justice, Memorandum: Enhanced Enforcement of the False Claims Act (June 11, 2025). [2] Press Release, U.S. Department of Justice, DOJ and HHS Announce Joint False Claims Act Working Group to Combat Healthcare Fraud (July 2, 2025). [4] HHS, Office of Inspector General, OIG Work Plan 2025-2026 (2025).
In the context of healthcare fraud enforcement, the Working Group has expressed interest in exploring potential litigation related to manipulation of electronic health records systems, aiming to stop inappropriate utilization of Medicare-covered products and services. Moreover, the focus on science is evident in the Working Group's emphasis on investigating drug, device, or biologics pricing, with an aim to uncover fraudulent practices that may compromise health-and-wellness.
