DOJ, HHS Join Forces to Support Federal False Claims Act

Healthcare professionals with insight into potential fraud against federal healthcare programs may soon find greater support from the federal government. On July 2, 2025, the U.S. Department of Justice (DOJ) and Department of Health and Human Services (HHS) announced a renewed joint effort to combat healthcare fraud and support whistleblowing in healthcare through an enhanced False Claims Act (FCA) Working Group.

The initiative focuses on key areas where fraud, waste and abuse are prevalent—and where whistleblowing in healthcare can play a vital role in helping the government recover taxpayer funds.

Federal False Claims Act: A Proven Tool Against Fraud

The federal False Claims Act has long been the government’s most powerful civil tool for addressing fraud. In fiscal year 2024 alone, the DOJ recovered more than $2.9 billion through FCA settlements and judgments. Over half of that—$1.6 billion—came from healthcare whistleblowers and related cases.

This new joint working group signals a renewed commitment to targeting systemic fraud in the healthcare system. Many enforcement actions under the FCA are initiated by whistleblowers, also known as “relators,” who bring qui tam lawsuits on behalf of the federal government. By law, whistleblowers are entitled to up to 30 percent of the funds recovered by the government.

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The initiative identifies the following priority enforcement areas:

• Medicare Advantage
• Drug, device or biologics pricing, including arrangements for discounts, rebates, service fees, and formulary placement and price reporting
• Barriers to patient access to care, including violations of network adequacy requirements
• Kickbacks related to drugs, medical devices, durable medical equipment, and other products paid for by federal healthcare programs
• Materially defective medical devices that impact patient safety
• Manipulation of Electronic Health Records systems to drive inappropriate utilization of Medicare covered products and services

Additional common types of healthcare fraud include:

• Billing Medicaid/Medicare for unnecessary urine, genetic, and psychological testing
• Underpaying rebates to the Medicaid program
• Provision of home health services to patients who were not homebound

Implications for False Claims Act Whistleblowers in Healthcare

Many fraud cases begin with individuals working inside healthcare organizations—physicians, nurses, billing specialists, coders, compliance officers, or former employees—who witness irregular practices but may be unsure how to report them. These people can then become healthcare whistleblowers by filing a case on behalf of the federal government.

The Whistleblower False Claims Act (FCA) allows private individuals to:

• File suit on behalf of the federal government;
• Remain confidential during the government’s initial investigation;
• Receive a share (typically 15–30%) of any money recovered.

Coming forward as a healthcare whistleblower is a serious decision—but it can also be a powerful way to protect patients, support honest providers, and recover taxpayer money lost to fraud. The renewed focus by DOJ and HHS signals that now, more than ever, whistleblowers are a critical part of the government’s enforcement strategy.

How Do We Fight Fraud Against the Government? 

Seek justice on behalf of taxpayers with the help of our experienced attorneys. Our Dallas, Texas, whistleblower team has battled corporate giants for decades, aggressively fighting to hold corporations, individuals, and other entities accountable for fraud committed against the government. If you believe you have a whistleblower case, we can help.