2026: JUSTICE IS TARGETING HEALTHCARE, NOW WITH AI

BE AWARE THAT AI IS THE DOJ’S TOOL.

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The False Claims Act (FCA) in the healthcare sector emphasizes compliance risks and strategies for healthcare organizations.

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This was pertinent in August 2025 and is still necessary today.

The Department of Justice (DOJ) is intensifying scrutiny on healthcare organizations for FCA violations, with 324 professionals charged in a recent fraud takedown involving over $14.6 billion in intended losses.
In 2024, the DOJ reported $2.9 billion in FCA settlements, with $1.67 billion from the healthcare sector.
Investigations are expanding into areas previously not seen as compliance risks, such as gender-affirming care and diversity, equity, and inclusion (DEI) programs.
Organizations must assess their compliance programs against new policies, especially regarding gender-related treatments and DEI initiatives, to mitigate litigation risks.

Pandemic-related fraud cases continue to emerge, with expectations of sealed cases becoming public as investigations conclude.
The DOJ’s focus on white-collar crime prioritizes healthcare, with ongoing investigations into billing practices, including services not rendered or medically unnecessary services.
Whistleblower actions are increasing, necessitating robust internal reporting systems to address potential issues before they escalate to external complaints.

The DOJ emphasizes that providers are responsible for ensuring accurate billing, even when using third-party billing services. Errors can lead to FCA violations.
Clinical laboratories and durable medical equipment providers remain high-risk areas for investigations, alongside specialty practices like pain management and dermatology.