Settlements and judgments under the False Claims Act (FCA) exceeded $6.8 billion in fiscal year (FY) 2025, ending September 30, 2025, the highest annual total in the history of the law, the Department of Justice (DOJ) announced on January 16, 2026. During the year, whistleblowers filed 1,297 qui tam lawsuits, setting a new record, and the government opened 401 investigations. Since 1986, when Congress strengthened the FCA, total recoveries have exceeded $85 billion.
Healthcare fraud remained a leading source of FCA settlements and judgments. Of the more than $6.8 billion collected in FY 2025, over $5.7 billion involved the healthcare sector. These recoveries restore funds to federal programs such as Medicare, Medicaid, and TRICARE, while also protecting patients from medically unnecessary or potentially harmful conduct. The DOJ focused on three key areas: managed care compliance, prescription drug fraud, and medically unnecessary care. In many cases, recoveries also supported state Medicaid programs.
In furtherance of its efforts to recover funds, the DOJ remained committed to incentivizing and rewarding entities and individuals that self-disclose misconduct, demonstrably cooperate in the course of an investigation, and take effective remedial measures. Several settlements over the last year acknowledged such cooperative measures and reflected credits afforded to the defendants in the form of reduced penalties or damage multiples in connection with the resolution. These cooperative measures can include self-disclosures, assistance with the determination of government losses, disclosures of internal investigations and facts not known to the government, and remedial measures such as implementing compliance program enhancements or terminating or separating culpable employees.
Access the press release and attached fact sheet here.
Compliance Perspective
Issue
In fiscal year 2025, healthcare fraud remained a leading source of FCA settlements and judgments. Submitting claims for unnecessary medical services not only misuses federal and state healthcare funds but can also put patients at risk or prevent them from receiving appropriate care. The FCA imposes treble damages and penalties on individuals and organizations that knowingly submit false claims or fail to repay funds owed to the government. Healthcare providers must maintain robust compliance and documentation practices to reduce exposure to FCA investigations and potential whistleblower actions.
Discussion Points
- Review your policies and procedures for preventing and reporting false claims, including processes to verify the accuracy of Medicare and Medicaid billing. Ensure these policies are reviewed at least annually and revised whenever there are regulatory updates or identified compliance risks. Many organizations find it helpful to work with an external consultant to assess current procedures, identify potential gaps, and provide guidance on compliance best practices and documentation standards.
- Provide training for all staff on compliance and ethics policies, what constitutes a false claim, and proper documentation practices. Training should occur upon hire and at least annually, with additional sessions for staff involved in billing, clinical documentation, and internal auditing. Med‑Net Academy offers the course Origin of Fraud, which covers the role of the Office of Inspector General (OIG) and the DOJ, Medicaid fraud control units and Medicare and DOJ fraud strike forces, federal monitoring of nursing homes, CMS nursing home enforcement and enforcement remedies, deficiency severity and scope levels, the origin of fraud, the importance of a compliance and ethics program and its required components, federal compliance-related laws, and guidance on what to do if contacted by government agents or investigators. This program helps staff understand both regulatory expectations and practical steps to protect their organization from exposure.
- Conduct periodic independent or consultant-led audits to review claims processes, documentation, and compliance procedures. These audits help identify potential risks, ensure that staff understand reporting responsibilities, and verify that internal controls such as claim verification or Triple Check processes are consistently applied. Findings should be documented and corrective actions implemented promptly to reduce potential exposure to FCA investigations and penalties.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*