Healthcare Fraud Enforcement Under a New Administration: Increasing Criminal and Civil Actions, Mitigating Client Risk

The new administration has indicated that it will be increasing its attention on rooting out healthcare fraud including a heightened focus on pursuing criminal actions against noncompliant healthcare entities. The DOJ's Criminal Division recently released its first ever White-Collar Enforcement Plan (the Plan) which indicates increased focus on 10 new priority areas of which three are related to healthcare, specifically "healthcare fraud," "fraud that threatens the health and safety of consumers," and "violations of the Controlled Substances Act and the Federal Food, Drug, and Cosmetic Act."

The Plan also introduces amendments to the DOJ's Whistleblower Program guidance which broaden the types of reports that may be eligible for rewards, including additional healthcare violations, and references a revised Corporate Enforcement and Voluntary Self-Disclosure Policy to incentivize companies to self-disclose potential violations. 

Although civil enforcement, including FCA litigation, is overseen by the DOJ's civil division, the criminal division's priorities and policies are indicative of the administration's general focus so that healthcare entities can expect no slowdown in civil enforcement action by DOJ as well. Additionally, HHS-OIG indicated in its first semi-annual report to Congress under the Trump Administration in June 2025 that it would continue to investigate healthcare fraud, with a particular focus on Medicare Advantage in which it has identified "a high risk of fraud, waste, and abuse."

With this increased government scrutiny on healthcare entities, counsel should understand where the focus of federal enforcement action may be and how to help their healthcare clients strengthen their compliance programs to mitigate risk.

Listen as our expert panel examines the new administration’s increased focus on healthcare fraud and offers best practices for helping healthcare clients navigate this evolving regulatory landscape.

I. Introduction

A. New administration's focus on healthcare fraud

II. DOJ

A. Criminal enforcement and the White-Collar Enforcement Plan

1. Healthcare fraud focus

2. Whistleblower program

3. Self-disclosure

B. Civil enforcement trends

II. HHS-OIG 

A. First semiannual report to Congress under new administration

B. Medicare Advantage

III. Impact on healthcare entities

A. Strengthening compliance programs

IV. Practitioner takeaways

The panel will review these and other key issues:

• How has the DOJ indicated an increased focus on healthcare fraud, particularly relating to criminal enforcement actions?
• What does HHS-OIG's first semiannual report to Congress under the new administration indicate as to its enforcement focus?
• What civil and criminal enforcement trends may healthcare entities expect under the new administration?
• What are best practices for assisting healthcare clients with strengthening their compliance programs under increased government scrutiny?