DOJ Fraud Division and HHS-OIG Announce Policy to Coordinate on Voluntary Self-Disclosures in Healthcare Fraud Matters

On October 15, 2026, the Department of Justice’s (DOJ) National Fraud Enforcement Division (“Fraud Division” or “Division”) and the Department of Health and Human Services Office of Inspector General (HHS-OIG) announced a coordinated policy (“Policy”) regarding voluntary self-disclosures involving healthcare fraud.

The Policy, issued by Fraud Division Assistant Attorney General Colin McDonald, instructs that companies need only disclose potential criminal conduct related to healthcare to the Fraud Division’s Health Care Fraud Section, and in doing so, will receive the benefits available under both DOJ’s Corporate Enforcement and Voluntary Self-Disclosure Policy (CEP) and HHS-OIG’s Self-Disclosure Protocol (SDP) without having to make a simultaneous disclosure to HHS-OIG directly. The Policy builds upon recent Fraud Division guidance on corporate prosecutions and seeks to streamline some of the elements that come into play when a company is deciding to self-disclose conduct.

The Fraud Division’s New Corporate Enforcement Program and Interagency Collaboration

This Policy follows on the heels of the Fraud Division’s release of a new corporate enforcement policy on October 1, 2026. That memorandum detailed the role of the Fraud Division’s own Corporate Enforcement Section and set forth principles and procedures for the Division’s corporate enforcement program.

As discussed previously by Goodwin, that memorandum reiterated that healthcare fraud remains a high priority for the Division and further directed Division leadership, “in consultation with law enforcement partners, to design and implement policies and programs that appropriately incentivize whistleblowers to bring forward credible information pertaining to fraud and provide the public with transparency to the extent possible regarding those policies and programs.”

The Division has not limited interagency collaboration to the disclosure process alone. Previously, the Division had also announced the National Fraud Detection Center (NFDC), a prosecutor-led, multi-agency data analytics center which utilizes data science, advanced analytics, and data-sharing agreements with federal and state agencies to proactively mine for and detect fraud patterns. HHS-OIG is among the participants in the NFDC.

Criminal Healthcare Matters Should Be Disclosed to the Fraud Division

Two weeks after the release of the Fraud Division’s corporate enforcement memorandum, the Fraud Division and HHS-OIG together have announced a new policy essentially directing that all healthcare fraud matters involving potential criminal conduct be disclosed to the Fraud Division.

The Policy acknowledges that healthcare fraud matters frequently implicate overlapping criminal, civil, and administrative enforcement involving DOJ and HHS-OIG. Highlighted examples include “an illegal remuneration arrangement, a scheme to bill for medically unnecessary services, or a scheme involving an excluded person.” Assistant Attorney McDonald said the Policy intends to “eliminat[e] unnecessary bureaucratic barriers that have caused confusion about whether companies must make multiple disclosures of potentially criminal conduct. There is now one clear point of contact: DOJ’s Fraud Division.”

Accordingly, the Policy establishes that:

1. A company that makes a qualifying voluntary self-disclosure regarding potentially criminal conduct involving a federal healthcare program to the Health Care Fraud Section will receive the benefits of both the CEP and the HHS-OIG’s SDP; and
2. A self-disclosure of potentially criminal conduct made only to HHS-OIG generally does not qualify as a voluntary self-disclosure to the Fraud Division.

HHS-OIG separately updated its Health Care Fraud SDP to clarify that criminal healthcare matters should be disclosed to DOJ. Upon receiving a disclosure, the Health Care Fraud Section will provide HHS-OIG with a copy of the disclosure — though the Policy does not expressly direct HHS-OIG to forward disclosures to the Health Care Fraud Section.

Notably, the Policy expressly states that “[a] disclosure discussed herein constitutes a voluntary self-disclosure to the Fraud Division only if it is made to the Fraud Division ... and satisfies each element of the definition of voluntary self-disclosure in the CEP.” (emphasis added). However, the CEP implies that this may be rectified if the matter is later brought to the appropriate component. The CEP also states that while good-faith disclosures to other federal, state, and local regulatory agencies or civil enforcement agencies generally do not qualify, such good-faith disclosures “may qualify if appropriate under the circumstances” and “[i]n all cases ... may be considered as part of a company’s cooperation and remediation.”

Takeaways

The Policy makes clear that companies should direct disclosure of any conduct potentially involving criminal healthcare fraud to the DOJ Fraud Division and can count on that disclosure to still afford them the potential benefits of disclosure under HHS-OIG’s SDP. While this provides clarity on conduct that may be under the purview of these two different agencies, it remains to be seen how companies and DOJ will handle voluntarily self-disclosures of conduct in healthcare fraud matters that touch upon the priorities of DOJ components other than the Fraud Division. This new Policy may incentivize self-disclosure to the Fraud Division. If, for example, a public healthcare company that participates in a federal healthcare program wants to disclose fraudulent financial activity, that may be among the DOJ Criminal Division’s traditional corporate enforcement priorities, but it may choose to direct the disclosure to the Fraud Division, out of an abundance of caution, to receive any potential benefits of this Policy and still receive the benefits of the CEP by making a later disclosure to the Criminal Division.

Consistent with recent announcements, the Policy further reflects the Fraud Division’s growing role in handling corporate enforcement matters, particularly those involving healthcare fraud. The Policy also signals increased coordination between the Fraud Division and HHS-OIG, long a partner of the Criminal Division, with the Fraud Division taking the lead.

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Goodwin’s Government Investigations, Enforcement & White Collar Defense lawyers will continue to monitor enforcement developments such as those described here and their potential implications. Please contact the Goodwin team with any questions related to these DOJ policies and if we can assist you with counsel in responding to any inquires or investigations.