Health Care Enforcement Trends & 2025 Outlook
In our annual report, we examine health care enforcement trends, predict how health care enforcement may evolve, and offer practical guidance about what these trends and predictions mean for health care providers, payors, and other stakeholders.
A Letter from the chair
Mintz's Health Care Enforcement Defense practice group is proud to present the latest issue of EnforceMintz, our regular newsletter analyzing current events, highlighting trends, and predicting future developments related to health care fraud enforcement. EnforceMintz reports on qui tam cases brought under the False Claims Act (FCA), other government enforcement actions, and significant regulatory developments and court decisions.
As in past years, this installment reflects on health care enforcement trends and predicts how health care enforcement may evolve and where enforcement authorities will focus their efforts and resources in years to come. We also offer practical guidance about what these trends and predictions mean for health care providers, payors, and other stakeholders.
While the Trump administration redux is expected to pursue sweeping changes in various areas, one constant is likely to be health care fraud enforcement. As we observed in 2021, in President Trump's first term, the total volume of FCA cases actually increased, which was the result of an increase in government-initiated enforcement actions. Similarly, overall FCA recoveries from 2017 to 2020 remained relatively constant, and, in each year, the health care industry was the main source of overall recoveries. Perhaps for that reason, health care fraud enforcement efforts generally have bipartisan support, and monetary recoveries help to fill the Medicare program's coffers, which could in turn help President Trump fulfill his campaign promise to reduce government spending without cutting Medicare or Social Security.
Pamela Bondi, President Trump's nominee for attorney general, is no stranger to health care fraud enforcement. She is the former attorney general for the State of Florida, which is a hotbed of government health care program fraud, but neither she nor President-elect Trump has expressed whether health care fraud enforcement will be a DOJ priority this time around. At her Senate confirmation hearing, Bondi stated that she would "defend the constitutionality" of the FCA and committed to ensuring that DOJ had sufficient staffing and resources to "properly support and prosecute" FCA cases, including those brought by qui tam relators.
Even if health care enforcement efforts slow under a second Trump administration, state-level enforcement may accelerate. Regardless, qui tam relators continue to drive the vast majority of FCA enforcement activities, and they show no signs of slowing down, so we anticipate that these matters will continue to reflect the trends and issues we have been following, as well as emerging theories of liability.
In this issue, we discuss 2024's areas of enforcement focus and our predictions for 2025. Some of the 2024 developments we analyze represent long-standing enforcement priorities while others signal emerging trends. We also cover regulatory policy developments, including DOJ's continued focus on cooperation and self-disclosure, and case law developments from 2024 that are expected to come to a head in 2025.
On January 15, 2025, DOJ released its annual report of FCA enforcement activity. In the last fiscal year, FCA settlements and judgments exceeded $2.9 billion, $1.67 billion of which related to matters involving the health care industry. DOJ handled 1,402 new FCA matters and qui tam relators filed 979 of those cases, a record number for a single year.
The next edition of EnforceMintz — our annual False Claims Act Statistical Year In Review — will analyze trends in FCA cases using data compiled by Mintz in its Qui Tam Database and dive into the data from DOJ's annual report.
Karen Lovitch
Chair, Health Care Enforcement Defense Practice
Areas of Enforcement Focus
FCA Enforcement in Value-Based Care Arrangements Heated Up in 2024 and Likely to Remain a Priority in 2025
Don't Forget Your Other Regulators: Consumer Protection Enforcement in Health Care Markets
Long Tail of Pandemic Fraud Schemes Will Likely Result in Continued Enforcement for Years to Come
Medicare Advantage and Part D Programs to Remain in the Enforcement Spotlight in 2025
Telemedicine Enforcement: Trends in 2024 Suggest More Sophisticated Enforcement to Come in 2025
Healing Healthcare? DOJ's Cybersecurity Enforcement Trained Up for 2025
2024's Key False Claims Act Settlements Involving Hospitals and Health Systems: Continued Focus on Stark Law and Anti-Kickback Statute Violations
Novel Criminal Charges and Emerging Civil Trends from Opioid Enforcement in 2024
Regulatory and Policy Developments
DOJ Policy Developments in 2024 Seek to Motivate More Voluntary Self-Disclosures
Additional Health Care Provider Joins the OIG's "Heightened Scrutiny" List in 2024
Case Law Developments
Scienter, Causation, and Constitutional Questions: 2024's Three Key FCA Litigation Issues
Could the Supreme Court's Decision in Jarkesy Mean the End to HHS Civil Monetary Penalty Authorities as We Know Them?
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.