The Department of Justice (DOJ) closed out its biggest False Claims Act (FCA) recovery year with more than $6.8 billion recovered, driven by record-breaking whistleblower activity and aggressive enforcement across health care, cybersecurity, procurement, and trade. With qui tam relators filing new FCA suits at a pace of five a day, the DOJ will continue to rely on relators to drive FCA activity.
Health Care Remains the Epicenter of FCA Risk
The DOJ and relators remain hyper-focused on the health care industry. Recurring targets and theories include:
- Medicare Advantage. A focus on coding practices, risk adjustment, and marketing issues resulted in sizable recoveries.
- Pharmaceutical and Life Sciences. Targeting prescription drug pricing, kickback allegations, and dispensing violations led to both trial verdicts and settlements.
- Health Care Providers. Providers saw a continued focus on medical necessity, substandard care, and relationships with referral sources that directly impact patient care.
Recoveries in this space drove approximately 83% of the year’s recoveries. For the first time, recoveries came primarily from cases where the government had not intervened, signaling that relator-driven, post-declination suits drove outcomes. Health care companies should take stock now and expand internal compliance efforts to identify gaps in these hot-button areas.
Cybersecurity, Procurement, Pandemic Fraud, and Trade Enforcement Expand
While health care remains the primary driver, we’ve seen continued attention on:
- Cybersecurity Enforcement. Cases targeted false cybersecurity certifications and vulnerable products provided to the government.
- Procurement & Defense Contracting. Major settlements involved issues with pricing, false cost data, and failure to meet contract specifications.
- Pandemic‑Related Fraud. There were more than 200 COVID‑related settlements in 2025, reinforcing the fact that pandemic program enforcement remains active.
- Customs & Tariff Evasion. The creation of a cross‑agency Trade Fraud Task Force signals growing attention to customs, tariff classification, and country‑of‑origin cases. The DOJ explicitly encouraged whistleblowers to bring qui tam actions in this space.
DOJ’s Recoveries in Declined Qui Tams Increased Significantly in FY 2025
In 2025, recoveries tied to declined qui tams increased dramatically, totaling more than 33% of the DOJ’s total recoveries. While the DOJ’s intervention decision remains a critical one, the increase in recoveries from declined qui tams reinforces the reality that exposure doesn’t end with the DOJ’s declination.
Constitutional Challenges Coming to a Head in 2026
Just last month, the Eleventh Circuit heard oral arguments in United States ex rel. Zafirov v. Florida Medical Associates in an appeal challenging the district court’s ruling that the False Claims Act’s qui tam provisions violate the Appointments Clause. During argument, the court inquired about the possibility of remand to allow the Middle District of Florida to consider constitutional challenges under the Vesting and Take Care Clauses. Zafirov is being closely monitored and will inform strategy for litigants defending against relator-driven FCA cases.
Key Takeaways for 2026
The FCA landscape will remain busy going into 2026, with a continued focus on health care and a potential increase in current administration priority areas like diversity, equity, and inclusion compliance, which can impact companies in all industries. Companies can proactively mitigate risk by focusing on compliance gaps, including ensuring relevant policies and company trainings are up to date.
Companies should engage counsel upon receipt of a relator’s complaint or civil investigative demand from the DOJ. Our False Claims Act Team is monitoring these trends.
If you have any questions, or would like additional information, please contact one of the attorneys on our False Claims Act team.
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