On August 22, 2025, US Attorney Andrew S. Boutros announced the formation of a new Healthcare Fraud Section within the Criminal Division of the US Attorney’s Office for the Northern District of Illinois. This is the first time the Office has established a team solely focused on investigating and prosecuting healthcare fraud, which remains a top enforcement priority for the US Department of Justice (DOJ).
As healthcare fraud remains a top priority for the DOJ, similar dedicated enforcement sections may be established in other regions, making it increasingly important for providers nationwide to maintain strong compliance programs.
The new section will consist of six federal prosecutors, including a Section Chief and Deputy Chief, both of whom bring decades of combined experience in investigating and prosecuting healthcare fraud. The remaining four are Assistant US Attorneys assigned full-time to the section.
This section will work in addition to the Healthcare Fraud Strike Force already operating out of the Chicago US Attorney’s Office. That Strike Force, led locally by Assistant Chief Patrick M. Mott, is part of the DOJ’s national Fraud Section and will continue to work closely with the new team.
The newly created section will focus on a wide range of healthcare fraud, including:
- Fraudulent claims submitted to Medicare, Medicaid, and other health insurers
- Billing scams such as “upcoding” (billing for more expensive services than provided) and “unbundling” (separately billing services that should be grouped together)
- Unnecessary or unsafe tests and procedures
- Kickback arrangements involving providers, facilities, or suppliers
“Every year, healthcare fraud causes billions of dollars in losses to the federal government and private insurers and siphons off hard-earned tax dollars meant to provide care for people in need,” said US Attorney Boutros. “Since becoming US Attorney, my Office has charged nearly $2 billion in healthcare fraud schemes involving alleged criminal conduct that has stretched across the country, and even transnationally. The newly created Healthcare Fraud Section that I’ve launched will bring greater focus, efficiency, and impact to our efforts in this important program area, which often involves the exploitation of patients through unnecessary and/or unsafe medical tests and procedures.”
Boutros added, “Under the direct leadership of our Section Chief and Deputy Chief, our Healthcare Fraud Section will continue to closely coordinate with the Healthcare Fraud Strike Force. Together, they represent a highly effective and dynamic prosecutorial team. Healthcare providers, gatekeepers, and others who criminally cheat the system will be vigorously investigated, prosecuted, and punished under federal law and in line with the Department’s priorities.”
Boutros also noted the continued collaboration with law enforcement and regulatory partners, including the FBI, DEA, HHS Office of Inspector General, US Department of Labor, FDA, Postal Inspection Service, and various state and local agencies.
The DOJ’s Health Care Fraud Unit, based in Washington, DC, will also continue its nationwide role. Since 2007, this unit has helped charge over 5,800 individuals across the country for schemes totaling more than $27 billion in fraudulent claims. One of its largest recent efforts—the National Health Care Fraud Takedown—resulted in charges against more than 320 defendants, involving over $14.6 billion in intended losses. This included the largest healthcare fraud enforcement action ever in Northern Illinois.
Compliance Perspective
Issue
The Department of Justice continues to prioritize the criminal prosecution of healthcare fraud, including schemes involving false billing, kickbacks, and other violations that impact federally funded healthcare programs. Recent enforcement efforts highlight the importance of maintaining strong, organization-wide compliance programs. Healthcare providers must remain proactive in preventing fraud, waste, and abuse to protect residents and patients, preserve government resources, and meet regulatory obligations.
Discussion Points
- Ensure your facility’s compliance and ethics program includes clear policies and procedures to prevent, detect, and respond to healthcare fraud. Regularly review and update these policies to stay current with new risks and ensure compliance with applicable laws and regulations. Consider working with a qualified consultant to help assess existing policies, identify risk areas, and support the development of focused compliance strategies tailored to your facility’s needs.
- Provide initial and ongoing training to all staff on recognizing and reporting fraud, waste, and abuse. Staff should be able to identify common risk areas in healthcare settings and understand the importance of ethical practices. Med-Net Academy offers the course, Origin of Fraud, which covers the roles of federal enforcement agencies such as the OIG and DOJ, the function of fraud strike forces, CMS enforcement processes, the fundamentals of compliance programs, and what to do if contacted by government investigators.
- Conduct periodic audits to evaluate adherence to compliance protocols, assess risk areas, and identify potential regulatory concerns. Facilities may benefit from external support when conducting focused reviews or mock surveys, especially in preparation for regulatory inspections or when addressing areas identified through the QAPI process. Use audit results to guide improvement plans and reinforce staff accountability.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*