Clinicians relying on templated electronic records may want to pay close attention to new federal actions. The U.S. Department of Justice (DOJ) and Department of Health and Human Services (HHS) announced a new phase in enforcement under the False Claims Act in July 2025. This latest wave explicitly targets the manipulation of electronic health records (EHRs) for fraudulent Medicare billing. Other insurance billing regulations are likely to follow suit.

This article reviews the current legal risks and compliance implications for providers under the expanding False Claims Act enforcement landscape.

New DOJ-HHS Working Group Expands False Claims Act Enforcement

The newly formed DOJ-HHS False Claims Act Working Group signals intensified oversight of healthcare billing practices. Led jointly by the HHS General Counsel, the Chief Counsel to the HHS Office of Inspector General (HHS-OIG), and DOJ’s Civil Division, the group will coordinate referrals, investigations, and enforcement actions tied to the False Claims Act.

Priority targets now include:

• Falsification or manipulation of EHR systems to justify services.
• Upcoding through pre-filled or templated documentation.
• Improper automation of billing triggers.
• Retroactive insertion of care that was not actually delivered.

Read the announcement here:
https://www.hhs.gov/press-room/hhs-doj-false-claims-act-working-group.html

$14.6 Billion Health Care Fraud Takedown Shows the Stakes

The False Claims Act continues to serve as the...

Read Full Story: https://news.google.com/rss/articles/CBMikAFBVV95cUxNWV9UWGVrV0FWb0ZHUktfd3Qy...