DOJ Introduces Two New Self-Disclosure Pathways for Health-Care Fraud
The Department of Justice now offers separate mechanisms for healthcare entities to self-report potential fraud, alongside a newly created criminal fraud division.
In late 2026 DOJ announced the formation of a new Criminal Fraud Division and two self‑disclosure pathways for health‑care fraud under the False Claims Act. One pathway allows voluntary submission of material fact findings to DOJ, offering statutory immunity versus cooperation and potential penalty reductions. Second pathway, via HHS‑OIG, lets entities submit internal claims under civil oversight, with potential civil sanctions but a more flexible process. These tools aim to lower reporting thresholds, encourage transparency, and streamline enforcement. Firms advising hospitals, insurers, pharma, or medical device companies must understand eligibility, procedural steps, and potential liabilities. Key actions include reviewing internal compliance policies, training staff on new reporting mechanisms, and monitoring DOJ guidance for updates on immunity, penalty mitigation, and timelines. Clients should evaluate whether high‑risk claims qualify for early disclosure and consider whether doing so could reduce exposure. The new division signals a heightened DOJ focus on healthcare fraud, so staying current on guidance and ensuring robust compliance is crucial.