LEGAL ALERT: Inside the 2026 National Health Care Fraud Takedown
The Department of Justice’s recent health care fraud takedown remains the largest in the agency’s history, with charges against 455 defendants, including 90 physicians and other licensed professionals, for schemes involving more than $6.5 billion in alleged false claims and significant patient harm. The enforcement action serves as a roadmap for DOJ’s current fraud enforcement priorities and signals where the DOJ will continue to focus enforcement efforts.
Background
The Takedown reflects the expansion of DOJ’s Health Care Fraud Strike Force program, which since March 2007 has charged more than 6,200 defendants alleged to have fraudulently billed federal health care programs and private insurers more than $45 billion. The DOJ’s recent June 2026 takedown followed its creation of the National Fraud Enforcement Division in April 2026, signaling a broader effort to coordinate federal benefit program oversight and fraud enforcement activities.
Data Analytics and AI
The 2026 Takedown demonstrated DOJ’s growing reliance on data analytics, financial intelligence, and artificial intelligence to identify potentially fraudulent activity earlier in the enforcement process. DOJ highlighted the role of its Data Fusion Center’s Financial Intelligence Review Team, which combines claims analysis with financial tracing to uncover suspicious billing activity. The Takedown illustrated the government’s ability to utilize large-scale claims data, financial transaction information, and data sharing to identify unusual billing patterns and root out health care fraud.
The Takedown also highlighted DOJ’s data-sharing agreement with Centers for Medicare and Medicaid Services (“CMS”), which gives DOJ direct access to CMS’s claims data, further supporting the government’s shift toward detecting and stopping improper payments before funds leave federal health care programs.
Notable Enforcement Areas
The Takedown highlights several areas of heightened enforcement risk.
Medicaid – DOJ’s largest Medicaid fraud enforcement action to date charged 295 defendants tied to more than $518 million in alleged false claims, underscoring its continued focus on fraud involving unprovided services, unnecessary care, and fraudulent billing affecting vulnerable populations.
Behavioral Health – DOJ is increasing scrutiny of behavioral health billing fraud, highlighting an Illinois scheme involving $67 million in alleged false claims for nonexistent services, excessive service hours, and unsupported billing.
Opioids and Controlled Substances – DOJ remains focused on unlawful prescribing, dispensing, and diversion, charging 36 defendants—including 28 licensed professionals—in cases involving overdose deaths and the unlawful distribution of millions of opioid pills.
Compliance Steps Providers Should Take Now
Several months later, the June 2026 Takedown remains an indicator of DOJ’s enforcement priorities. Health care fraud investigations are becoming increasingly data-driven, coordinated across government agencies, and focused on identifying billing irregularities at earlier stages. Providers should evaluate whether they are set up to identify and address compliance risks before they become the subject of regulatory action. Providers can take several steps now to bolster their programs:
- Prioritize compliance reviews in high-risk service lines and reimbursement programs
- Monitor for billing spikes, excessive service volumes, overlapping claims, and patterns inconsistent with staffing or facility capacity
- Confirm that services were medically necessary, actually provided, properly documented, and compliant with program requirements
- Review referral, marketing, and compensation arrangements for compliance risks
- Maintain a response plan to preserve records, involve legal counsel early on, and prevent improper documentation changes
If you have any questions regarding compliance, investigations, audits, subpoenas, or other enforcement matters, please contact Kessler Collins’s team of experienced attorneys to assist you in navigating these challenges and protecting your interests.
