DOJ’s New Fraud Division Memo Signals a More Aggressive, Data-Driven Enforcement Era

The Department of Justice’s (DOJ) recent memorandum outlining the National Fraud Enforcement Division’s priorities offers more than a routine statement of agency focus. It signals a meaningful structural and strategic shift in how DOJ intends to investigate and prosecute fraud going forward.

The memo makes clear the Division will concentrate its resources on fraud that threatens the “health, safety, security, and prosperity of Americans,” with emphasis on five areas: public trust and financial integrity, health care, internal revenue, global trade and commerce, and corporate misconduct. But beyond those headline categories, several aspects of the announcement stand out for companies and their executives.

Most notably, DOJ is pairing these priorities with a stated commitment to cutting-edge data analytics, broader interagency coordination, and a more integrated enforcement model. The result is likely to be earlier detection, faster charging decisions, and more cases that blend traditional fraud theories with tax, trade, health care, and corporate enforcement components.

The Headline Priorities

According to the memo, the Fraud Division will prioritize enforcement in five principal areas:

• Public trust and financial integrity, including procurement fraud and grant and benefit fraud (e.g., student loans, childcare benefits, veterans’ benefits, and so forth);
• Health care fraud, including telemedicine, Medicare and Medicaid fraud, controlled substance diversion, home health and hospice schemes, and deceptive marketing of unsafe products and services;
• Internal revenue enforcement, targeting tax fraud, abusive preparers, false returns, and tax violations tied to broader fraud schemes;
• Global trade and commerce, including customs evasion, tariff fraud, sanctions evasion, forced labor related supply chain issues, and country-of-origin misrepresentations; and
• Corporate misconduct, with continued emphasis on organizational accountability, self-disclosure, cooperation, and remediation.

While this article focuses on the memorandum’s health care component, stay tuned for further articles that will explore federal program fraud as well as the tax and global trade implications in greater depth.

DOJ Will Continue to Follow the Data

One of the clearest messages in the memo — and one that has been building for years — is that DOJ increasingly views data analytics as central to fraud enforcement. The memo repeatedly emphasizes the Division’s goal of becoming a more “sophisticated, innovative, and data-driven” enforcement component, backed by data scientists, automated litigation support, and a National Fraud Detection Center.

This focus on data is especially important in health care, particularly given that federal programs like Medicare and Medicaid generate vast amounts of data. We have seen an uptick in data-driven investigations in our practice, and the fact that DOJ has emphasized data analytics and enforcement signals an increased focus in this area.

What This Means for Health Care Companies

For health care companies, the key takeaway is straightforward: DOJ is building a more centralized, technologically enabled fraud enforcement model. That means greater risk of enforcement in areas like billing practices, kickback arrangements, and program compliance — areas where health care organizations may previously have experienced fragmented federal oversight.

In light of these developments, companies should consider several practical steps:

• Reassess health care fraud risk
  • Health care fraud risk assessments should not be confined to a single legal or business function. Compliance, internal audit, revenue cycle, coding, finance, and clinical leadership should coordinate to identify areas where one set of facts — such as improper billing or kickback arrangements — could create multiple forms of exposure.
• Pressure-test billing and claims data
  • With DOJ leaning into analytics, health care companies should do the same. That means testing claims data, billing patterns, coding accuracy, referral relationships, discount and rebate arrangements, and reimbursement trends for outliers and unexplained anomalies. Understanding what the data shows – before the government asks questions about it – can be vastly beneficial. Early identification of potential issues can reduce exposure and better position the company to respond effectively if an investigation arises.
• Integrate tax into internal investigations
  • Potential health care fraud matters should be evaluated for tax implications early. If a company uncovers questionable revenue, the company and its counsel should evaluate remediation options.
• Prepare for overlapping enforcement theories
  • Health care companies should assume that a single issue may be framed simultaneously as fraud, tax misconduct, false statements, or corporate control failure. Investigation and response plans should reflect that possibility.
• Invest in remediation before a problem becomes an investigation
  • Well-documented compliance enhancements, training, auditing, disciplinary measures, and escalation procedures may help reduce risk and improve the company’s position if a government inquiry arises.

• Consider Self-Disclosure
  • While not a new concept, the memorandum reiterates DOJ’s commitment to hold “accountable organizations that flaunt the law and reward[ ] those that voluntarily self-disclose, cooperate, and remediate.” Although numerous factors must be weighed when determining whether self-disclosure is appropriate, the memorandum underscores DOJ’s intent to meaningfully reward companies that take a proactive approach. 

Bottom Line

DOJ’s memo is not just a list of priorities. It is a blueprint for a more integrated fraud enforcement regime — one that is larger, more technologically sophisticated, and potentially more willing to combine multiple theories in a single case. In this environment, proactive compliance, coordinated risk assessment, and early investigative discipline are more important than ever.