What's Happening?
The U.S. Department of Justice (DOJ) is set to enhance its enforcement of the False Claims Act (FCA) in 2026, focusing on areas such as health care fraud, AI-enabled misconduct, and civil rights-based
claims. The DOJ's efforts will include increased scrutiny of recipients of federal funds, including health-care companies and importers, with a more integrated approach involving cross-agency coordination. The DOJ-Health and Human Services FCA Working Group, established in July, aims to streamline investigative strategies and prioritize cases involving waste, fraud, and abuse in federal health care programs. Additionally, the DOJ is scaling up the use of artificial intelligence as an enforcement tool, as demonstrated by the 2025 National Health Care Fraud Takedown, which uncovered over $14.6 billion in fraud. The DOJ's Civil Rights Fraud Initiative will also focus on compliance as a pathway for fraud and abuse exposure, particularly where federal funds are involved.
Why It's Important?
The DOJ's intensified focus on FCA enforcement has significant implications for various sectors, particularly those receiving federal funds. Health care providers, manufacturers, and distributors may face increased government-originated inquiries and data-driven issue spotting. The use of AI in enforcement could lead to more efficient detection of fraud, impacting how organizations manage compliance and risk assessments. The DOJ's emphasis on civil rights fraud and DEI initiatives could lead to increased scrutiny of institutions receiving federal funds, potentially affecting higher education, health systems, and research entities. The expansion of FCA enforcement into customs and tariff fraud highlights the government's commitment to addressing trade-related misconduct, which could impact importers and their supply chain practices.
What's Next?
Organizations affected by the DOJ's enhanced FCA enforcement should prepare for increased scrutiny by reviewing and updating their compliance programs. Health care organizations, in particular, should focus on aligning their analytics and documentation with DOJ and HHS priorities. Importers should enhance their diligence and compliance efforts, especially in high-risk transshipment areas. Private equity owners may need to document proactive oversight to mitigate risks associated with portfolio company FCA violations. As the DOJ continues to develop its enforcement strategies, organizations should remain vigilant and responsive to evolving regulatory expectations.
