Federal regulators are signaling that healthcare fraud enforcement is not slowing down in 2026, and in some cases, it may accelerate.
Recent guidance and enforcement updates suggest physicians should expect closer scrutiny of billing, documentation, industry relationships and compliance certifications under the False Claims Act.
Here are 10 things to know:
1. Healthcare fraud enforcement remains a top federal priority. According to a Jan. 9 blog post from law firm Arent Fox & Schiff in JDSupra, the Justice Department and the Office of Inspector General are signaling continued commitment to investigating and prosecuting fraud and abuse.
2. The Justice Department and the Office of Inspector General have revived the False Claims Act Working Group and built it to move cases faster. It’s positioned to streamline and expedite investigations, identify new leads and leverage HHS resources.
3. Medicare Advantage risk adjustment is a recent target. The law firm emphasized diagnosis risk scores and points to major settlements tied to unsupported diagnosis codes and inflated payments, meaning documentation and coding support will face heavier scrutiny.
4. Kickbacks and physician-facing benefits remain a central enforcement lane. The post highlights continued focus on payments/perks tied to prescribing or referrals, such as speaker fees, meals, sham consulting, travel and entertainment. Physician-industry relationships will need tight guardrails and documentation.
5. EHR and documentation integrity are now explicit priorities. The post flagged EHR manipulation and vendor inducements and misrepresentations as enforcement concerns, implying more attention to tools that can inflate utilization or drive questionable coding.
6. According to a blog post from law firm Husch Blackwell posted Jan. 5 in JDSupra, qui tam constitutionality challenges could reshape whistleblower mechanics. The firm described a growing debate over whether FCA qui tam provisions violate the Appointments Clause, with more appellate scrutiny expected in 2026.
7. Physicians should also expect more interagency coordination and proactive data-mining in healthcare cases, since the FCA Working Group aimed at unified priorities, faster referrals, and advanced analytics. This raises the odds of “agency-found” investigations, not just whistleblower-driven cases, according to the post.
8. Husch Blackwell lists focus areas like Medicare Advantage risk adjustment, kickbacks, defective devices, EHR manipulation and drug/device pricing schemes, which could signal deeper scrutiny of how care is documented, billed and contracted.
9. The FCA is expanding into new compliance “front doors,” including cybersecurity certifications with the DOJ’s Civil Cyber-Fraud Initiative and FCA cases tied to false cybersecurity attestations and incident-reporting failures.
10. Husch Blackwell argues that federal grants with anti-discrimination compliance certifications — and DOJ encouragement of FCA suits tied to allegedly illegal DE&I practices — create risk if public statements/attestations don’t match actual practices.
