The suggestion that the Trump administration may not be committed to enforcing healthcare fraud has been clearly countered by two recent developments. First, on July 2, 2025, the U.S. Department of Justice (DOJ) and the Department of Health and Human Services (HHS) announced the creation of a new Joint False Claims Act Working Group to coordinate fraud and abuse behaviors between several agencies. The working group will be staffed by members of the HHS Advisors' Office, CMS' Program Integrity Centre, the Attorney's Office of the HHS Inspector's Office (OIG) and the DOJ Civics Department representing coordinated efforts to strengthen and expand FCA enforcement actions. Second, in late June, DOJ announced its 2025 national health fraud takedown with over $14.6 billion in fraud.
Joint False Claims Law Working Group
First focusing on the Joint False Claims Act Working Group, DOJ Leadership explicitly identified traditional enforcement priorities, including Medicare advantages, kickbacks, drug and device pricing schemes, as the ongoing goals of FCA action. However, the DOJ announcement also highlighted the focus on traditional, lower priority areas, including network validity requirements, barriers to patient access to care, and promoting inappropriate use of care through the use of EMR systems.
DOJ's leadership showed at the recent American Health Law Association conference that the working group will seek to advance the Trump administration's policy goals through the FCA. Brenna Jenny, a DOJ lawyer who leads the working group, shows that in May the group released the first announcement of newly formed civil rights fraud in May, calling for the group to enforce policy goals reflected in executive orders related to diversity, equity, and inclusion (DEI) policies, gender-affirming care, gender ideology and combating anti-Semitism. Given the amount of litigation that challenges some of the administration's executive orders and the changing legal environment surrounding the national injunction, it ensures that modern compliance programs will be important for healthcare organizations in preparing for the potential enforcement of managerial policy goals.
In addition to expanding the enforcement area of priority, the working group will reconsider its enforcement tactics, such as an increase in the use of suspension of payments under 42 CFR section 405.730. Under the regulations, CMS has long been authorized to withhold payments for credible claims of fraud, but regulations are rarely used in the FCA context. Currently, DOJ and HHS may utilize the threat of suspension of payments more frequently to increase pressure on healthcare providers and payers in aggressive FCA litigation cases.
2025 National Healthcare Health Care Fraud Takedown
Moving on to the 2025 national health fraud takedown, DOJ promoted record-breaking numbers. The takedown has resulted in criminal charges against 324 defendants, including 96 doctors and other licensed medical professionals. The DOJ reported that the intended losses from the fraudulent scheme totaled over $14.6 billion, with the government seized more than $245 million in cash, luxury vehicles, cryptocurrency and other assets. A civil settlement with 106 defendants totaling $34.3 million has also been announced. CMS has also suspended or revoked claim privileges for 205 providers in connection with Takedown.
The DOJ highlighted one international scheme in particular. The defendant purchased dozens of healthcare providers nationwide and promptly filed fraudulent claims against Medicare for urinary catheters and other durable medical devices. The defendant filed these claims using the stolen identities and confidential medical information of more than one million Americans. The Healthcare Fraud Unit's data analytics team identified fraudulent claims and prevented payments for all but $41 million of the $4.45 billion that Medicare plans to pay. Twenty-nine defendants have been charged with participating in the scheme, including the largest loss ever claimed in a healthcare fraud case.
Illegal wound care, illegal opioid trafficking, telehealth and genetic testing fraud were other areas of emphasis in takedowns. DOJ also announced that it is creating a Healthcare Fraud Data Fusion Centre to promote government data analytics efforts to identify potential healthcare frauds. The Data Fusion Center brings together experts from DOJ's Healthcare Fraud Data Analytics team, HHS-OIG, FBI and other agencies to “utilise cloud computing, artificial intelligence and advanced analytics to identify new healthcare fraud schemes.”
Action in Washington, Oregon and California
In Washington, Oregon and California, actions announced as part of Takedown. (1) Civil settlement regarding claims for injectable amniotic fluid treatment that are deemed experimental. (2) A $44 million scheme that allegedly pays an illegal kickback to a marketing company in exchange for a doctor's medically unnecessary orthodontics order. (3) It is said that there will be false diagnosis and referrals of hospice patients. (4) A $2.7 million scheme that is said to refer a substance abuse treatment center to patients. (5) A scheme in which Medi-Cal allegedly utilized the suspension of pre-authorization requirements to file an expensive drug claim for a refund.
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With the announcement of new working groups and takedowns, the DOJ revealed that healthcare fraud and abuse are being highlighted under the Trump administration, and that the FCA will continue to be the cornerstone of government enforcement efforts. While traditional priority areas will continue to be focused, enforcement actions expanded in conjunction with new enforcement groups, and an increase in data analytics poses new risks and challenges for stakeholders across the industry. DWT will continue to monitor development due to new working groups and healthcare fraud and abuse trends.
