On July 2, 2025, the Department of Justice (“DOJ”) and the Department of Health and Human Services (“HHS”) announced a joint DOJ-HHS False Claims Act Working Group (the “Working Group”) that will focus on enhanced enforcement of the False Claims Act (“FCA”) to combat healthcare fraud. The Working Group announced six priority enforcement areas and outlined additional areas of focus that the Working Group will explore. The announcement of the Working Group is notable both in underscoring the Administration’s continued prioritization of FCA healthcare enforcement and in setting forth priority areas in addition to those identified in the Civil Division’s June 11, 2025 memorandum, which the Working Group announcement references.¹

The Working Group will look to expedite ongoing investigations in the identified priority areas, including through an increased use of data mining. The six priority areas are:

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, durable medical equipment, and other products paid for by federal healthcare programs.
5. Materially defective medical devices that impact patient safety.
6. Manipulation of electronic health records systems to drive inappropriate utilization of Medicare-covered products and services.

The...

Read Full Story: https://news.google.com/rss/articles/CBMiuAFBVV95cUxNNU0zVEh4WmpQZE1GSmxhR2Vs...