The United States Department of Justice (DOJ) has ratcheted up its efforts to pursue actions against corporations, healthcare entities, and individuals, including physicians, for false Medicare or Medicaid billing and COVID-19-related loans. Billing claims that are deemed misleading may result in a DOJ investigation. DOJ touted a record $6.8 billion in False Claims Act (FCA), 31 U.S.C. §§3729-3733, recoveries in fiscal year 2025. On June 23, 2026, DOJ announced 455 arrests, including a number of physicians, for allegations of healthcare fraud and opioid abuse. This aggressive enforcement appears to be a top priority of the current administration.

As part of this announcement, the Centers for Medicare and Medicaid Services (CMS) suspended 1,079 providers and revoked billing privileges for 1,403 providers. There were 48 civil monetary payment settlements amounting to more than $73 million; over 1,400 provider exclusions; 25 Department of Health and Human Services Office of Inspector General (OIG) actions under the Civil Monetary Penalties Law seeking more than $10 billion in payments to the Medicare Trust Fund from payments that CMS caught and suspended before the funds were paid to the providers; civil charges against 13 defendants for $14.8 million in healthcare fraud schemes, as well as civil settlements with 31 defendants totaling $23 million. The Drug Enforcement Administration has sought the revocation of authority to handle and/or prescribe controlled substances for...

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