2026 has opened with unmistakable signals that False Claims Act (“FCA”) enforcement in the health care sector is accelerating. On January 16, 2026, the Department of Justice (“DOJ”) announced a record-breaking $6.8 billion in FCA settlements and judgments for fiscal year (“FY”) 2025—the largest annual total in the statute’s history and roughly a 120% increase since 2024. Health care once again dominated. Approximately $5.7 billion (84% of recoveries) related to health care. The DOJ’s Civil Division reported nearly 500 new FCA cases initiated in just the second half of FY 2025, and whistleblower-initiated qui tam filings reached their highest level since the statute was enacted.
Against this backdrop, several Q1 developments stand out for their potential to reshape the compliance landscape for health care providers, payors, investors, and their counsel.
Medicare Advantage Under the Microscope
Medicare Advantage (“MA”) remains squarely in the government’s crosshairs. In March 2026, Aetna Inc. agreed to pay $117.7 million to resolve FCA allegations that it submitted or failed to correct inaccurate diagnosis codes for its MA Plan enrollees to increase risk-adjustment payments from the Centers for Medicare & Medicaid Services (“CMS”). The settlement stemmed in part from a qui tam filed by a former Aetna risk-adjustment coding auditor. Notably, although they resolved these allegations under the FCA, Aetna refused to enter into a corporate integrity agreement (“CIA”) with...
Mombasa County Commissioner Mohamed Noor said investigations conducted so far have found no evidence that any victim had actually lost their genital organs despite widespread rumours circulating ...