DOJ’s healthcare fraud takedown 2025

The Department of Justice (DOJ) recently announced another of its annual healthcare fraud “takedowns.” Consistent with previous takedowns, this year’s announcement touts criminal charges against 324 individuals (96 of whom are providers) and a massive amount of fraudulent billings (approximately US$14.6 billion). This annual “shock-and-awe” enforcement spectacle reinforces the government’s focus on combatting healthcare fraud … and Texas remains a major focal point for these efforts.

DOJ’s annual takedown press releases provide insight into the Department’s current healthcare fraud enforcement priorities. Front-and-center in this year’s announcement was the DOJ’s focus on transnational criminal organizations, citing egregious instances of foreign actors obtaining access to Medicare payments, fleecing the system and laundering proceeds to foreign countries. Not surprisingly, diversion of opioids and fentanyl remains a major focus. Additionally, the DOJ identified fraudulent wound care, telemedicine, durable medical equipment and laboratory billing as areas of scrutiny. Finally, the DOJ also signaled its continued interest in Covid-19 related billing fraud. Unlike previous years, but consistent with the messaging of this administration’s DOJ, Attorney General Bondi touted enforcement operations targeting schemes that take advantage of “our most vulnerable citizens” and “steal from hardworking taxpayers.” Health and Human Services Secretary Robert F. Kennedy, Jr. added:

“As part of making healthcare accessible and affordable to all Americans, HHS will aggressively work with our law enforcement partners to eliminate the pervasive health care fraud that bedeviled this agency under the former administration and drove up costs.”

To that end, the government noted proactive approaches by HHS to prevent lost government funds by suspending or revoking billing privileges of 205 providers, along with civil investigation settlements with 106 defendants. Doubling down on the collaborative approach, the DOJ also announced the creation of a Health Care Fraud Data Fusion Center that appears to be an escalation of existing commitments to inter-agency investigations with a stated intent to continue and improve the deployment of technology (artificial intelligence, could computing and advanced data analytics) to find and prosecute targets.

None of this was unexpected, especially given DOJ’s May 11 memo identifying health care fraud as a top enforcement priority. Thus, it doesn’t take a crystal ball to predict increased attention by federal, state, civil, administrative and criminal enforcement teams on health care fraud. A healthy compliance mind-set is more important than ever.

Norton Rose Fulbright’s experienced Healthcare Investigations team represents businesses and executives in government investigations. If you find yourself involved in a government investigation, or if you receive a government subpoena or civil investigative demand (CID), our team will defend your interests aggressively and effectively. Please let us know what we can do to help.