On July 2, 2025, the Departments of Justice and Health & Human Services announced a joint working group aimed at “strengthening their ongoing collaboration to advance priority enforcement areas” under the False Claims Act (FCA) – described in the announcement as “one of the government’s most effective and successful tools” for fighting fraud. In Fiscal Year 2024, the Department of Justice recovered more than $2.9 billion through settlements and judgments under the FCA, with $1.6 billion (57%) coming from healthcare-related matters.

The Departments identified six priority enforcement areas:

1. Medicare Advantage;
2. Drug, device, or biologics pricing, including arrangements for discounts, rebates, service fees, and formulary placement and price reporting;
3. Barriers to patient access to care, including violations of network adequacy requirements;
4. Kickbacks related to drugs, medical devices, DME, and other products paid for by federal healthcare programs;
5. Materially defective medical devices that impact patient safety; and
6. Manipulation of Electronic Health Records systems to drive inappropriate utilization of Medicare covered products and services.

Some of these priorities, like Medicare Advantage and kickback schemes, are continuations or evolutions of long-standing priority areas for FCA enforcement. Others are more noteworthy, like prioritization of barriers to patient access to care. Medicare, Medicaid managed care, and the Affordable Care Act impose network adequacy...

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