Major settlements involved Medicare Advantage insurers, including Independent Health Association ($98 million) and Kaiser Permanente ($556 million), alongside pharmaceutical manufacturers facing kickback allegations, pharmacy chains, and healthcare providers. The DOJ Criminal Division designated healthcare fraud as its top white-collar enforcement priority. Separately, over 1,200 qui tam whistleblower suits were filed in FY 2025, a record, with relators recovering approximately $5.3 billion. In July 2025, the DOJ and HHS renewed their joint FCA Working Group to coordinate investigations. The Trump Administration established a new National Fraud Enforcement Division in January 2026 and announced plans to create Medicare and Medicaid fraud prosecution programs in 15 U.S. Attorney's Offices.
Healthcare providers and insurers should anticipate sustained federal scrutiny of billing practices, compliance certifications, and care access barriers. Enforcement priorities now explicitly include Medicare Advantage diagnosis coding fraud, drug pricing violations, kickbacks, and medically unnecessary procedures. The expansion of dedicated enforcement infrastructure and record whistleblower participation signal that healthcare organizations face heightened exposure across managed care, pharmaceutical arrangements, and provider billing.