The Department of Justice (“DOJ”) and the Department of Health and Human Services (“HHS”) announced the re-establishment of a DOJ-HHS False Claims Act (“FCA”) Working Group, originally created in 2020, to combat healthcare fraud in the United States. The working group is jointly led by senior officials from both agencies, including the HHS Office of General Counsel, the Centers for Medicare & Medicaid Services Center for Program Integrity, the HHS Office of Inspector General, and DOJ’s Civil Division. This partnership reflects the government’s ongoing commitment to use the FCA as a central enforcement tool against fraud, waste, and abuse in federal healthcare programs.
Under the FCA, any person who knowingly submits false claims to the government may be liable for up to three times the actual damages, plus additional penalties for each violation. In 2024, the federal government secured over $2.9 billion in settlements and judgments related to fraudulent claims. Yet only $93 million involved HHS cases, representing the lowest recovery amount since 2009. The working group is expected to meet monthly and expand the use of whistleblower incentives and advanced analytical tools, including artificial intelligence and data mining, to accelerate investigations and pinpoint fraudulent activity earlier.
The Working Group identified the following priority areas:
– Drug, device, or biologics pricing, including arrangements for discounts, rebates, service...
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