Federal Agencies Launch Joint False Claims Act Working Group to Combat Healthcare Fraud

Federal officials have announced a significant strengthening of healthcare fraud enforcement efforts with the creation of a new joint False Claims Act (FCA) Working Group. The Department of Justice (DOJ) and Department of Health and Human Services (HHS) unveiled the initiative on July 2, 2024, signaling an intensified approach to combating fraud in the healthcare sector.

The announcement comes amid record-breaking FCA recoveries in 2024 and represents a strategic shift toward more coordinated enforcement actions between the two agencies. This collaboration aims to dismantle the traditional siloed approach that has sometimes hampered investigation efficiency.

The working group will operate under the joint leadership of HHS Acting General Counsel Sean Keveney, HHS-OIG Acting Chief Counsel Susan Edwards, and DOJ Commercial Litigation Branch Deputy Assistant Attorney General Brenna Jenny. Key divisions participating in the initiative include the HHS Office of Inspector General, HHS Office of General Counsel, Center for Program Integrity at the Centers for Medicare & Medicaid Services, the DOJ Civil Division, and various U.S. Attorney’s Offices across the country.

“This collaborative approach should streamline decision-making and enforcement efforts,” noted a healthcare compliance expert familiar with the announcement. “We could see investigations move more quickly and the government’s ability to pursue more fraud leads substantially enhanced.”

The working group has identified several priority enforcement areas that align with existing agency concerns. Medicare Advantage will be a primary focus, with investigators examining allegations of improper risk factor reporting and diagnostic coding irregularities. With millions of participants and a substantial share of Medicare funding, this program has drawn increased scrutiny in recent years.

Other key enforcement priorities include drug, device, and biologics pricing—particularly arrangements involving rebates, discounts, service fees, and price reporting. The group will also target barriers to patient care access, kickback schemes related to federally reimbursed products, defective medical devices that impact patient safety, and manipulation of electronic health records that could drive inappropriate utilization of Medicare-covered services.

A defining feature of the initiative is its commitment to data-driven enforcement. At the American Health Law Association Annual Meeting on July 2, 2024, Brenna Jenny emphasized that while whistleblower complaints will remain welcome, the agencies will increasingly pursue their own cases using sophisticated data mining and analysis to identify fraud patterns.

“We’re entering a new phase where government enforcers won’t wait for whistleblowers to flag potential issues,” said a healthcare fraud defense attorney who requested anonymity to discuss the development. “They’re building capability to proactively detect problems using the vast data resources at HHS’s disposal.”

Jenny also indicated that the working group will focus on evaluating novel legal theories early in investigations and will consider whether the DOJ should invoke its authority to dismiss qui tam (whistleblower) complaints when appropriate under federal statute.

For healthcare organizations, providers, and industry stakeholders, this development signals the need for enhanced compliance vigilance. The coordinated approach between agencies, combined with more sophisticated data analytics capabilities, creates a more robust enforcement environment than previously existed.

Healthcare compliance experts recommend that organizations review their internal controls, documentation practices, and compliance programs in light of the announced priority areas. Particular attention should be given to risk adjustment practices in Medicare Advantage programs, pricing transparency, patient access protocols, and relationships with vendors or referral sources that could potentially implicate anti-kickback statutes.

The creation of this working group aligns with broader Biden administration efforts to strengthen enforcement across various regulated industries, with healthcare remaining a particular focus due to its substantial share of federal spending.