Department of Justice Announces Record Healthcare Fraud Takedown Led by New Fraud Enforcement Division

On June 23, 2026, the Department of Justice (DOJ) announced the results of its 2026 National Health Care Fraud Takedown, including criminal charges against 455 defendants across 56 federal districts and 45 states and territories in connection with alleged healthcare fraud schemes that DOJ stated involved more than $6.5 billion in false claims. Acting Attorney General Todd Blanche described the effort as “the greatest whole-of-government effort” to combat healthcare fraud in the nation’s history.

This year’s national takedown was the first to be announced under the auspices of DOJ’s National Fraud Enforcement Division, which was created earlier this year. Notably, DOJ’s announcements included the first-ever prosecution arising from the newly formed Financial Intelligence Review Team of DOJ’s Data Fusion Center, a continuation of DOJ’s emphasis on leveraging data analytics in investigating and prosecuting healthcare fraud cases. DOJ’s use of enhanced data access and sharing across government agencies, as well as the government’s analytics capabilities, reflects the implementation of several new initiatives promulgated in recent months and the priorities announced in a number of recent executive orders.

Although DOJ’s annual healthcare fraud takedowns have long served as a hallmark enforcement initiative, this year’s announcement reflects several important developments that industry participants, including healthcare providers, life sciences companies, pharmacies, and investors, should closely monitor. In particular, the takedown announcement illustrates the government’s rapid expansion of data analytics, growing cross-agency and transnational coordination, increasing reliance on administrative enforcement tools, and continued focus on voluntary self-disclosure and corporate compliance — all deployed in connection with this administration’s “laser focus” on healthcare and federal benefit fraud.

A New Era of Data-Driven Healthcare Fraud Enforcement

For years, DOJ’s Health Care Fraud Unit has distinguished itself by leveraging claims data and advanced analytics to identify aberrant billing patterns and prioritize investigations. For example, in 2019, DOJ Criminal Division’s Fraud Section highlighted its use of sophisticated data analytics to identify healthcare fraud “hot spots” and maximize recoveries for federal healthcare programs. Those efforts reportedly generated substantial returns for taxpayers while helping prevent billions of dollars in additional losses.

Historically, however, DOJ’s analytical capabilities were constrained by fragmented government data systems. Investigators often faced significant barriers to accessing information maintained by other federal agencies, requiring separate agreements and lengthy coordination before datasets could be combined for investigative purposes.

That landscape has since changed significantly. Following Executive Order 14243 on stopping waste, fraud, and abuse by eliminating information silos in 2025 — and as we observed in a prior alert — the government has substantially expanded information sharing across agencies. This year’s takedown demonstrates how DOJ has moved quickly to capitalize on those authorities by integrating broader datasets, expanding its analytical capabilities, and developing new investigative tools that allow prosecutors and investigators to identify fraud schemes more quickly and comprehensively. For example, one of the investigations resulting in the announced enforcement actions was prompted by a detected abnormal spike in payment for allografts; another was initiated after the Financial Intelligence Review Team ascertained that patients were hospitalized at other institutions on days that the defendant fraudulently billed for behavioral health services.

Along with the announced enforcement actions, DOJ also unveiled new data-sharing arrangements with the Centers for Medicare and Medicaid Services (CMS), the Department of Homeland Security (DHS), and the Federal Trade Commission. Notably, DOJ stated it will now operate cloud-computing resources within CMS’ Integrated Data Repository to deploy advanced analytics and artificial intelligence tools designed to identify emerging fraud schemes.

Coordination Across Agencies and Borders

As in past years, this takedown reflects significant contributions from many federal and state entities. This enforcement effort involved not only DOJ, Federal Bureau of Investigation (FBI), Department of Health and Human Services Office of Inspector General (HHS-OIG), and CMS, but also the Drug Enforcement Administration (DEA), DHS, Department of Veterans Affairs, state Medicaid Fraud Control Units, and many state and local law enforcement agencies.

The announcement also pointed to “unprecedented international cooperation.” DOJ reported the apprehension and extradition of several members of transnational criminal organizations, including an individual appearing on the FBI’s Most Wanted Fraudsters List, who was apprehended in the Philippines. These developments demonstrate that healthcare fraud investigations increasingly extend beyond domestic enforcement and rely on coordinated international partnerships.

Administrative Enforcement Continues to Expand

In addition to the takedown, DOJ announced a range of recent administrative actions taken in healthcare fraud cases alongside traditional criminal prosecutions. The government announced the following:

• Suspension of 1,079 providers from federal healthcare programs
• Revocation of billing privileges for 1,403 providers
• More than 900 DEA administrative actions since October 2025
• 48 civil monetary penalty settlements amounting to more than $73 million, more than 1,400 provider exclusions, and 25 actions by HHS-OIG under the Civil Monetary Penalties Law seeking more than $10 billion in payments to the Medicare trust fund from payments that the CMS caught and suspended before the funds were paid to fraudulent providers

Historically, annual healthcare fraud takedowns focused primarily on criminal charges. While last year’s takedown announcement did emphasize select administrative actions by CMS, HHS-OIG, and DEA, it did not approach this scale and scope. This particular announcement demonstrates the range of administrative remedies available to these agencies to combat healthcare fraud, and it reflects a broader enforcement strategy in which criminal investigations are increasingly paired with administrative actions capable of immediately disrupting provider operations. For healthcare companies and practitioners, these parallel proceedings may significantly increase operational risk while creating important strategic considerations when responding to government investigations.

Enforcement Priorities Remain Focused on High-Dollar Fraud and Patient Safety

Consistent with recent enforcement trends, DOJ emphasized schemes involving substantial losses to federal healthcare programs and conduct that presents potential patient safety concerns. Some of the matters highlighted included the following:

• An alleged nationwide amniotic wound allograft kickback scheme involving more than $2 billion in Medicare payments and more than $24 million in profit for a single defendant
• A $67 million behavioral health fraud scheme identified through DOJ’s newly established Financial Intelligence Review Team, which combined healthcare claims analysis with financial intelligence
• An $89 million scheme to bill for unnecessary cardiovascular tests in student athletes that included alleged falsified results and diagnoses, which the government alleges potentially resulted in failure to adequately detect and diagnose an enlarged heart condition in a student athlete that led to that patient’s death
• Continued emphasis on Medicaid fraud, with participation of 50 state Medicaid Fraud Control Units

The behavioral health prosecution is particularly noteworthy because it represents the first case generated through the new Financial Intelligence Review Team, underscoring the government’s continued investment in integrating financial intelligence with healthcare claims analytics.

Practical Takeaways

This year’s takedown offers several important lessons for industry participants.

Evaluate Compliance Programs. DOJ’s continued investment in sophisticated data analytics means providers should evaluate whether their own compliance programs incorporate comparable data-driven monitoring capabilities. Organizations that can identify anomalous billing patterns internally may be better positioned to remediate issues before they become government investigations.

Consider Whether Self-Disclosure is Appropriate. False Claims Act (FCA) enforcement reached a record high in fiscal year 2025, including an all-time high of qui tam whistleblower suits (and we can expect those historic rates to continue). Since then, DOJ has announced an accelerated review process for qui tams alleging benefits fraud and a Fraud Oversight through Careful Use of Statistics initiative designed to leverage data mining in its FCA investigation processes. Given this aggressive enforcement approach, organizations confronting potential compliance issues should consult experienced counsel promptly to evaluate whether, when, and to which agencies self-disclosure may be appropriate. When facing potential criminal exposure, the evaluation of when to self-disclose becomes critically important because DOJ’s recently revised Corporate Enforcement and Voluntary Self-Disclosure Policy places increased importance on early decision-making. Because voluntary self-disclosure generally requires disclosure before DOJ independently identifies misconduct, the government’s expanded analytical capabilities may significantly shorten the window during which companies can obtain maximum cooperation credit.

Healthcare Fraud Remains a Key Enforcement Priority. The announcement reinforces that healthcare fraud remains among the government’s highest enforcement priorities. The combination of enhanced data analytics, unprecedented information-sharing, international cooperation, and aggressive use of criminal and administrative enforcement tools suggests that healthcare investigations are likely to become faster, broader, and more coordinated than ever.

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The Goodwin Healthcare team will continue to monitor these developments and their potential impact on healthcare providers, life sciences companies, pharmacies, and other industry participants. For more information on the issues discussed in this alert, please contact the authors, reach out to Goodwin's Government Investigations, Enforcement & White Collar Defense or Healthcare groups, or contact the Goodwin lawyer with whom you typically consult.

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