Overview
Executive Summary
The Trump Administration has reaffirmed its commitment to aggressive health care enforcement, continuing the priorities of the previous administration. A recent memorandum from DOJ Criminal Division head Matthew Galeotti emphasizes targeting health care fraud, consumer safety violations, and illegal drug distribution. The False Claims Act (FCA) also remains a central tool, with the DOJ pledging to pursue both whistleblower-initiated and government-led cases. Additionally, President Trump's Executive Order 14221 mandates stricter enforcement of health care price transparency, particularly targeting hospitals and insurers for opaque pricing practices. Health care entities are urged to strengthen compliance programs in anticipation of heightened scrutiny and enforcement.
The Full Read
While the Trump Administration has ushered in significant changes to the Department of Justice's (DOJ) and other federal agencies' enforcement priorities, all indications suggest that the administration will continue the previous administration's focus on robust civil and criminal enforcement in the health care space. Health care businesses, including providers, insurance companies, and pharmaceutical companies, should continue to invest in robust compliance programs, including with respect to pricing, competition, fraud, and diversion.
I. Galeotti Memorandum Focuses on Health Care Enforcement
On May 12, 2025, Matthew Galeotti, head of the DOJ's Criminal Division, issued a memorandum addressing "enforcement priorities and policies for prosecuting corporate and white-collar crimes."1 The Galeotti memorandum states that health care enforcement will be a key priority for the Criminal Division, noting that "[r]ampant health care fraud and program and procurement fraud drain our country's limited resources." Specifically, the Galeotti memorandum states that the "Criminal Division will prioritize investigating and prosecuting white-collar crimes in the following [10] high-impact areas," including the following health care-related offenses:
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"Waste, fraud, and abuse, including health care fraud and federal program and procurement fraud,"
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"[F]raud that threatens the health and safety of consumers; [and]"
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"Violations of the Controlled Substances Act and the Federal Food, Drug, and Cosmetic Act (FDCA), including the unlawful manufacture and distribution of chemicals and equipment used to create counterfeit pills laced with fentanyl and unlawful distribution of opioids by medical professionals and companies."
Also, on May 12, the DOJ updated its guidance on its handling of corporate whistleblower cases, which allows, under certain circumstances, people who report corporate misconduct to share in the proceeds of any forfeiture. The updated guidance continues to emphasize incentivizing whistleblowers to report health care fraud.2
II. False Claims Act Remains Key Tool in Health Care Enforcement
For decades, the FCA has been a critical tool for the federal government in combating fraud, waste, and abuse in the health care sector. The Trump Administration has signaled early on that it will continue to use the FCA as a key enforcement tool in the health care space.
On February 20, 2025, Michael Granston, deputy assistant attorney general of DOJ's Commercial Litigation Branch, stated in public remarks that the Trump Administration will continue "aggressively" enforcing the FCA.3 In his speech, Granston highlighted the successful deployment of the FCA to combat health care fraud, noting that government spending to investigate health care fraud between 2021 and 2023 has been recovered nearly three-fold.4 Granston also cited a study concluding that the Centers for Medicare and Medicaid Services fraud prevention partnership estimates that about $10 in potential fraud is deterred for every $1 recovered.5
FCA claims are typically initiated by whistleblower qui tam actions, and it is expected that the majority of FCA claims will continue to derive from these actions. That said, recent trends show the DOJ has increased its own investigations leading to FCA cases, and this trend is likely to continue under the Trump Administration.6
III. Health Care Pricing and Quality Transparency
During President Trump's first term in office, he signed Executive Order 13877, directing the Secretaries of Treasury, Labor, and Health and Human Services to take measures to "[1] eliminate unnecessary barriers to price and quality transparency; [2] increase the availability of meaningful price and quality information for patients; [3] enhance patients' control over their own health care resources, including through tax-preferred medical accounts; and [4] protect patients from surprise medical bills."7
On February 25, 2025, President Trump signed Executive Order 14221,8 directing the Secretaries of Treasury, Labor and Health and Human Services "to rapidly implement and enforce the health care price transparency regulations issued pursuant to Executive Order 13877." Specifically, Executive Order 14221 requires the Secretaries to take the following steps:
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"require the disclosure of the actual prices of items and services, not estimates"
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"issue updated guidance or proposed regulatory action ensuring pricing information is standardized…[and]"
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"issue guidance or proposed regulatory action updating enforcement policies designed to ensure compliance with the transparent reporting of complete, accurate, and meaningful data"
Executive Order 14221 specifically targets the allegedly "opaque pricing arrangements" of hospitals and insurance companies.9 It aims to close enforcement gaps, claiming that hospitals and insurance companies have not been "adequately held to account when their price transparency data was incomplete or not even posted at all."10 As a result, hospitals and insurance companies should expect stricter federal rules regarding the disclosure of pricing information and more robust enforcement actions. In particular, hospitals and insurance companies may face heightened scrutiny for discrepancies between listed and final billed charges, as organizations will now be required to provide actual, not estimated, prices. The call for greater standardization may also affect how this information must be disclosed in the future.
Conclusion
The Trump Administration has made clear that it intends to continue prioritizing robust enforcement in the health care sector. Businesses should review their compliance programs to ensure they align with the administration’s priorities and strengthen their compliance frameworks. This includes conducting internal audits, updating training programs, and ensuring transparency in pricing and billing practices. Legal and compliance teams should stay informed on evolving DOJ guidance and executive orders to proactively address enforcement risks. Taking these steps today can help mitigate legal exposure and position your organization for long-term regulatory success.
With extensive experience in health care fraud, tax fraud, antitrust matters, and government and internal investigations, the authors can provide the tailored legal advice you need to respond to these enforcement priorities and compliance challenges. For guidance and support, please contact them directly.
1 Matthew R. Galeotti, Focus, Fairness, and Efficiency in the Fight Against White-Collar Crime (May 12, 2025), available at https://www.justice.gov/criminal/media/1400046.
2 Dep't of Just., Department of Justice Corporate Whistleblower Awards Pilot Program 6 (2025), https://www.justice.gov/criminal/media/1400041/dl?inline.
3 Daniel Wilson, DOJ Official Flags 'Aggressive' FCA Approach Under Trump, Law360 (Feb. 20, 2025) https://www.law360.com/articles/2300751/doj-official-flags-aggressive-fca-approach-under-trump
4 Id.
5 Id.
6 Dep't of Just., Fraud Statistics – Overview (2025), https://www.justice.gov/archives/opa/media/1384546/dl.
7 Exec. Order No. 13877, 84 Fed. Reg. 30849 (Jun. 24, 2019), https://www.federalregister.gov/documents/2019/06/27/2019-13945/improving-price-and-quality-transparency-in-american-healthcare-to-put-patients-first.
8 Exec. Order No. 14221, 90 Fed. Reg. 39 (Feb. 28, 2025), https://www.federalregister.gov/documents/2025/02/28/2025-03440/making-america-healthy-again-by-empowering-patients-with-clear-accurate-and-actionable-healthcare.
9 Id.
10 Id.
