Colin M. McDonald, Assistant Attorney General for the National Fraud Enforcement Division of the Department of Justice, recently announced a plan to prioritize rooting out fraud within the United States. The announcement points to five areas of focus: healthcare fraud, internal revenue, global trade and corporate misconduct as well as rebuilding public trust.
A new era of fraud enforcement
The creation of the National Fraud Enforcement Division, announced by Attorney General Todd Blanche in April 2026, signals a shift in how the federal government approaches white-collar crime. This new division aims to consolidate resources and expertise to target fraud more aggressively. Healthcare fraud has emerged as one of five key enforcement targets.
Five areas under the microscope
The memorandum identifies specific areas of focus that will receive concentrated prosecutorial attention, including allegations of the following:
- Telemedicine fraud involving inappropriate prescribing or billing for services not rendered
- Medicare and Medicaid billing schemes that drain billions from federal healthcare programs
- Opioid diversion operations that fuel the ongoing addiction crisis
- Hospice fraud exploiting end-of-life care programs
- Deceptive marketing practices that mislead patients and payers
The agency states these areas represent some of the most costly and harmful fraud schemes affecting the American healthcare system. The DOJ’s focus on telemedicine is particularly noteworthy given the explosive growth of virtual care during and after the pandemic.
What this means for healthcare organizations
Healthcare providers, technology companies and related entities must recognize that business as usual will no longer suffice. The heightened enforcement environment demands proactive compliance measures. Organizations should conduct comprehensive reviews of their billing practices to help better ensure accuracy and appropriate documentation. Marketing materials and patient communications also require scrutiny to check for any potentially misleading claims.
Telemedicine programs deserve special attention, particularly regarding prescribing protocols and medical necessity determinations. Perhaps most importantly, as artificial intelligence and algorithmic decision-making become more prevalent in healthcare, organizations must work to ensure these technologies comply with applicable regulations and do not facilitate fraudulent billing or inappropriate care decisions.
The path forward
The DOJ’s announcement serves as both warning and opportunity. While enforcement will intensify, organizations that invest in robust compliance programs can protect themselves from liability while improving patient care. The message from the National Fraud Enforcement Division is unmistakable: healthcare fraud will be prosecuted vigorously, and those caught in the crosshairs should take the matter seriously.
Attorney John Rivas is responsible for this communication.