Department of Justice and Health and Human Services Establish a New False Claims Act Task Force
DOJ-HHS False Claims Act Working Group Announced to Combat Healthcare Fraud
In a joint announcement by the Department of Justice (DOJ) and the Department of Health and Human Services (HHS) on July 2, 2025, a new False Claims Act (FCA) Working Group has been established to enhance enforcement efforts against healthcare fraud. Deputy Assistant Attorney General Brenna Jenny of DOJ's Civil Division will co-lead the Working Group.
The Working Group's focus is on streamlining investigations and expediting ongoing probes in identified priority areas. These areas include Medicare Advantage, drug pricing, patient access to care, kickbacks, defective medical devices, manipulation of electronic health records, and other substantive practices the administration aims to deter.
In the realm of Medicare Advantage, the Working Group will particularly focus on risk adjustment fraud. For drug, device, and biologics pricing, the Working Group will scrutinize arrangements involving discounts, rebates, service fees, formulary placement, and price reporting.
Barriers to patient access to care will be addressed by investigating violations of network adequacy requirements. The Working Group will also look into kickbacks related to drugs, medical devices, durable medical equipment, and other federally reimbursed products.
Materially defective medical devices impacting patient safety are another priority area, as is manipulation of electronic health records systems to drive inappropriate usage of Medicare-covered products and services.
The Working Group will also consider HHS's payment suspension authority for "credible allegations of fraud." Under the DOJ Justice Manual, several factors can serve as the basis for dismissal, including duplication of a preexisting government investigation, interference with government policies or programs, and implication of classified information and national security interests.
Allegations are considered credible when they have "indicia of reliability." HHS defines a credible allegation of fraud broadly, including from fraud hotline tips, claims data mining, provider audits, civil false claims cases, and law enforcement investigations.
Participants in federal healthcare programmes should monitor whether the Working Group identifies additional considerations bearing on when HHS should exercise its payment suspension authority.
WilmerHale's team, with its experience in successfully defending against FCA investigations and litigation brought by qui tam relators and the government, is prepared to assist clients in investigations and enforcement actions brought against them.
Upcoming Working Group meetings may provide more details. The announcement underscores the Administration's continued prioritization of FCA healthcare enforcement.
[1] DOJ-HHS False Claims Act Working Group Announcement: https://www.justice.gov/opa/pr/department-justice-and-department-health-human-services-announce-joint-doj-hhs-false-claims [2] Civil Division Memorandum (June 11, 2025): https://www.justice.gov/civil/page/file/1386776/download [3] WilmerHale's Experience in FCA Investigations and Litigation: https://www.wilmerhale.com/en/practices/litigation/white-collar-defense-investigations/false-claims-act
- The DOJ-HHS False Claims Act Working Group, focused on combating healthcare fraud, will scrutinize arrangements involving discounts, rebates, service fees, formulary placement, and price reporting in the realm of Medicare Advantage, drug, device, and biologics pricing.
- In addition to addressing kickbacks related to drugs, medical devices, durable medical equipment, and other federally reimbursed products, the Working Group will also investigate materially defective medical devices impacting patient safety and manipulation of electronic health records systems to drive inappropriate usage of Medicare-covered products and services.
