DOJ and HHS Form Working Group to Intensify Health Care Fraud Enforcement

The US Department of Health and Human Services (HHS) and the US Department of Justice (DOJ) announced the formation of the DOJ-HHS False Claims Act (FCA) Working Group, a joint initiative designed to strengthen enforcement efforts against health care fraud. The False Claims Act has long been one of the most effective legal tools for addressing fraud, and this new working group formalizes a coordinated strategy to pursue high-priority violations.

The working group will be comprised of senior leaders from the HHS Office of General Counsel, the Centers for Medicare & Medicaid Services Center for Program Integrity, the Office of Counsel to the HHS Office of Inspector General (HHS-OIG), and DOJ’s Civil Division. It will also include representatives from US Attorneys’ Offices across the country. The group will be jointly led by the HHS General Counsel, the Chief Counsel to HHS-OIG, and the Deputy Assistant Attorney General of the Commercial Litigation Branch.

As part of its mandate, HHS will refer potential violations of the FCA that align with the working group’s enforcement priorities. These priorities include fraud involving Medicare Advantage programs, drug and medical device pricing arrangements such as discounts and formulary placements, violations of network adequacy standards that limit patient access to care, kickbacks related to products covered by federal health care programs, materially defective medical devices that pose safety risks, and the manipulation of electronic health records to drive improper utilization of Medicare services.

The working group aims to expedite investigations by enhancing cross-agency collaboration, leveraging HHS data resources, and drawing on findings from prior HHS and OIG reports. Discussions within the group will also explore whether HHS should implement payment suspensions in specific cases or whether DOJ should dismiss certain whistleblower complaints, in accordance with established legal frameworks and the Justice Manual.

The DOJ-HHS False Claims Act Working Group is actively encouraging whistleblowers to report suspected fraud, waste, and abuse related to its priority areas. Health care companies are similarly encouraged to self-disclose potential violations in accordance with DOJ guidelines.

This announcement signals intensified oversight, particularly around Medicare Advantage operations, pricing practices, and network compliance. The formation of the working group marks a significant step in aligning federal enforcement tools to ensure accountability and safeguard the nation’s health care system.

Reference

DOJ-HHS False Claims Act Working Group. Press release. US Department of Justice, Office of Public Affairs. Published July 2, 2025. Accessed July 2, 2025. https://www.justice.gov/opa/pr/doj-hhs-false-claims-act-working-group