A recent Chief Healthcare Executive article examined the federal government’s increasing focus on healthcare fraud enforcement, highlighting record levels of False Claims Act (FCA) recoveries and whistleblower activity. Bass, Berry & Sims attorney Taylor Chenery shared insights on what these trends mean for healthcare providers and why organizations should expect continued scrutiny from the Department of Justice (DOJ).
Commenting on the DOJ’s reported $6.8 billion in FCA settlements and judgments during fiscal year 2025, including $5.7 billion tied to healthcare matters, Taylor noted that while healthcare enforcement has long been a government priority, recent data suggests a meaningful increase in activity. “There are some signs of increased activity on the front end,” he said, pointing to a growing number of FCA investigations involving healthcare providers and companies. Taylor added that fiscal year 2025 represented “the highest single year of monetary recovery under the False Claims Act since the DOJ started reporting those statistics about 40 years ago now.” According to Taylor, healthcare enforcement “shows no signs of slowing down” and may be experiencing an uptick beyond historically consistent levels of government oversight.
Taylor also highlighted the record number of whistleblower, or qui tam, lawsuits filed in recent years, noting that increased enforcement activity and large recoveries may encourage more individuals to come forward. “Whistleblowers are not just out there and alive and well, and paying close attention, but also taking that additional extra step to go to the court and file an action,” he said. He further observed that healthcare organizations should pay close attention to several high-profile FCA resolutions, including significant settlements involving prescription drug and reimbursement allegations.
Looking ahead, Taylor emphasized the importance of proactive compliance efforts and data monitoring. “I think the most common mistake, and at a very high level, is being more reactive than proactive,” he said, explaining that providers should identify and assess potential issues internally before they are raised by regulators or whistleblowers. Taylor also noted that federal agencies are increasingly relying on data analytics and artificial intelligence to identify potential fraud concerns. As a result, healthcare organizations should assume the government is conducting detailed reviews of claims and coding data. “All healthcare providers, and particularly health systems that may be operating broadly and submitting a significant number of claims, need to be keenly aware of what their own data reflects,” he said.
As enforcement agencies continue to leverage advanced analytics and pursue both whistleblower-driven and government-initiated investigations, Taylor noted that healthcare providers should expect FCA enforcement to remain a significant compliance risk and ensure they have robust monitoring and response processes in place.
The full article, “The government is going after healthcare fraud. What health systems should know.” along with a video clip of Taylor’s interview with the reporter, was published by Chief Healthcare Executive on July 30 and is available online.