The Department of Justice (DOJ) is continuing its efforts to leverage data analytics and AI-related tools to increase civil prosecutions under the False Claims Act (FCA). In July 2025, the U.S. Department of Justice (DOJ) and the Department of Health and Human Services (HHS) announced the formation of a new working group dedicated to FCA enforcement. The group will focus on identifying and addressing fraud, waste, and abuse in several priority areas, including Medicare Advantage, drug pricing, medical device safety, and manipulation of electronic health records.
Many of the announced efforts appear to be data-oriented. For example, the working group will review data and regulatory information obtained by HHS, with the goal of identifying emerging issues and overlooked areas of potential FCA liability. In addition to traditional enforcement priorities such as kickbacks, the group will also examine violations related to network adequacy requirements, which may impede patient access to care, as well as the use of materially defective medical devices and inappropriate utilization of Medicare-covered products and services driven by electronic health record manipulation.
On the more traditional side, the working group will also consider the use of DOJ’s statutory authority to dismiss qui tam complaints and HHS’s authority to suspend payments to providers based on credible allegations of fraud.
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