Health care fraud enforcement is evolving rapidly in 2025. The Department of Justice (DOJ) has recommitted to its oversight of fraud and abuse in government-funded health programs. As part of its toolkit, artificial intelligence is increasingly used to detect suspicious billing patterns. And as investigations increase, health care providers are seeing heightened scrutiny of compliance practices and False Claims Act (FCA) exposure.
Griffin Durham Tanner & Clarkson LLC can help providers navigate these demands. Speak with a healthcare fraud lawyer if you have questions about audits, subpoenas, or government inquiries.
Why has healthcare fraud enforcement remains active?
Even with a general retreat in certain white collar enforcement areas, recent government actions show that both civil and criminal healthcare fraud cases remain a major focus this year. The DOJ continues to put resources into investigating and prosecuting white-collar cases that drive up costs for government insurance programs or restrict patient access to necessary care.
Investigators are also using advanced data tools to spot unusual billing patterns that could signal fraud. These tools help uncover issues tied to telemedicine visits and high-cost prescription drugs. Federal and state agencies continue to use the False Claims Act to hold healthcare organizations and licensed providers responsible when they knowingly submit claims that lack proper support.
The Joint False Claims Act Working Group’s focus areas
In July 2025, the DOJ and Department of Health and Human Services (HHS) announced a new Joint False Claims Act Working Group designed to coordinate enforcement efforts across agencies involved in federal health program oversight.
The Working Group includes members of the DOJ Civil Division, HHS Office of Inspector General, HHS Office of General Counsel, and CMS program integrity experts. Their role is to investigate allegations of fraud and pursue FCA penalties where improper billing is detected.
The focus areas include:
- Medicare Advantage payment accuracy
- Kickbacks related to referrals or product use
- Drug and device pricing schemes that inflate reimbursement
More attention is being placed on:
- Network adequacy and access to care
- Misuse of electronic medical records for billing
- Schemes that target vulnerable or high-risk patient populations
What did the latest national healthcare fraud enforcement results show?
In June 2025, federal agencies announced major results from a nationwide enforcement initiative targeting criminal and civil healthcare fraud exposure. Hundreds of defendants across the country were charged with participating in schemes involving improper billing and misrepresentation of medical services.
Cases included allegations related to telehealth billing irregularities, wound care, skin substitutes, kickbacks, durable medical equipment orders without medical necessity, claims involving stolen patient identities, and more. These efforts reflect a sustained DOJ commitment to investigating large-scale fraud as well as localized misconduct.
How are providers being impacted by these enforcement trends?
Government agencies are pursuing more audits and investigations compared to prior years. Providers may receive subpoenas, civil investigative demands, or requests for claims data as part of large multi-state inquiries.
Federal investigators now have faster access to billing analytics and data-sharing networks, which can increase the speed at which concerns escalate to criminal or civil review. Even unintentional documentation mistakes can raise enforcement questions if they appear systemic.
Providers in Georgia and nationwide need to ensure compliance practices reflect the latest rules, especially those related to medical necessity, telehealth documentation, and billing transparency.
How can providers prepare for healthcare fraud scrutiny in 2025?
There are practical steps organizations can take to reduce exposure. For example:
- Review claims data for outliers that may prompt government interest
- Confirm documentation supports billed services and medical necessity
- Monitor licensure and enrollment status for all treating providers
- Make sure telehealth billing aligns with current CMS guidance
- Maintain clear policies that discourage kickbacks and improper financial relationships
Internal audits and legal consultation can help identify gaps before investigators take action.
How Griffin Durham Tanner & Clarkson LLC supports clients under investigation
Providers facing government scrutiny often feel pressure to respond quickly and disclose information immediately. Yet engaging counsel early can help protect rights and improve outcomes. Effective defense typically includes managing communications with investigators, assessing the scope of data requests, preserving evidence, and identifying compliance strengths. We also help address allegations before they escalate to criminal charges.
The firm includes former federal prosecutors who understand how the DOJ builds health care fraud cases and what strategies may be available to challenge assumptions, correct inaccuracies, and reduce enforcement risks. Contact us online, call our Atlanta office at (404) 891-9150, or get in touch with our Savannah office at (912) 867-9140 to discuss your situation with a healthcare fraud defense attorney.
