Key areas of enforcement

• Medicare Advantage: Both Granston and Yavelberg noted a focus on Medicare Advantage (Part C). Given that Medicare Advantage covers about half of all Medicare funds and millions of participants, fraud prevention is a key priority. The DOJ expects to continue to focus on allegations of improper reporting of risk factors and incorrect diagnostic coding, as well as potential kickbacks.
• Cybersecurity: As a result of the increasing number of high-profile data breaches and national security risks, the DOJ plans to increase its focus on cybersecurity and proper reporting of these breaches, including based on alleged non-compliance with federal cybersecurity requirements.
• Customs and tariffs: Granston and Yavelberg also noted its continued focus on customs and tariff avoidance cases, including dedicating increased resources with the expectation that this will be a growth area of enforcement.
• Pandemic relief fraud: This is a continuing priority for the DOJ, with more than 600 settlements and judgments already reached in this area.

Practical regulatory insights

• Know your data: Granston noted that data analytics continue to help the government combat fraud more efficiently, especially in health care. For our clients, we recommend understanding your data because the government or potential whistleblowers will be reviewing it. In particular, Granston noted that the government often looks for “extreme outliers.” As such, comparing your data to your peers and ensuring you can explain any dramatic differences could help you mitigate risk and get ahead of potential enforcement action.
• Be proactive: For defense lawyers, Granston recommends swiftly bringing key facts and legal issues to the government’s attention, disclosing key evidence as quickly as possible, and considering whether self-disclosure or early resolution of pending matters is appropriate.
• Be aware of potential FCA risks: While most high-profile FCA cases have historically involved government contractors or health care companies, which will likely continue to account for the majority of FCA recoveries, companies in other industries may become targets of the DOJ’s FCA efforts. These could include technology companies, energy companies, importers and exporters, companies providing federal disaster relief, and any other company doing business with the federal government.

This year, the FBA’s Annual Qui Tam Conference includes sessions on many of these priorities (including cybersecurity fraud, pandemic fraud, and Medicare Part C fraud), as well as other hot topics, such as “cause to be submitted” health care fraud and exploring how AI will impact the FCA landscape.

Client Alert 2025-058