HHS-OIG Decertifies New York Medicaid Fraud Control Unit, Escalating Federal Scrutiny of State Medicaid Fraud Enforcement
The Administration has taken another significant step in its effort to increase pressure on state Medicaid Fraud Control Units (“MFCUs”). On July 2, 2026, the United States Attorney’s Office for the Northern District of New York announced the U.S. Department of Health and Human Services Office of Inspector General (“HHS-OIG”) denied recertification of New York’s MFCU and suspended its federal funding effective July 1. The decision follows the Administration’s announcements earlier this year that it would closely scrutinize state MFCU performance, including through funding consequences for states perceived as failing to aggressively investigate and prosecute Medicaid fraud.
DOJ’s 2026 Health Care Fraud Takedown Highlights Increased Coordination and Data-Driven Enforcement
This week, DOJ announced the results of its 2026 National Health Care Fraud Takedown, which involved charges against 455 defendants, including 90 medical professionals, in connection with alleged schemes involving more than $6.5 billion in false claims submitted to Medicare, Medicaid, and other federal health care programs. The Takedown involved the participation of 50 state Medicaid Fraud Control Units and included cases in 56 federal districts and 45 U.S. states and territories.
New Clarity Emerges on DOJ’s Fraud Enforcement Reorganization
In remarks delivered on June 3, 2026, at the American Conference Institute’s Global Anti-Corruption, Ethics & Compliance Conference in New York City, Assistant Attorney General A. Tysen Duva, the head of the U.S. Department of Justice’s (“DOJ”) Criminal Division, provided the clearest public indication to date of how DOJ intends to divide fraud enforcement responsibilities between the Criminal Division’s Fraud Section and the newly created National Fraud Enforcement Division (“NFED”).
Under the emerging structure, NFED will focus on government program fraud, i.e., criminal offenses involving public payers and public systems, including taxpayer-funded programs, while the Criminal Division’s Fraud Section will remain focused on private-sector market, consumer, and corporate fraud matters—a traditional strength of the Unit previously known as Market Integrity & Major Frauds, which will remain part of the Criminal Division. Duva further emphasized that the Fraud Section will be focusing on securities and major financial fraud schemes, global fraud, and prediction markets, and is actively looking to further build capacity by hiring talented lawyers.
The remarks largely confirm earlier expectations that DOJ would eventually provide greater clarity regarding the respective roles of the Criminal Division and NFED following NFED’s creation. We examine what Duva’s comments reveal about DOJ’s enforcement priorities, staffing changes, and the implications for future enforcement activity.
Drug Pricing and Medicaid Rebate Reporting: Enforcement Risk Remains
A recent analysis examines ongoing enforcement risks tied to drug pricing and Medicaid rebate reporting under the Medicaid Drug Rebate Program (MDRP), focusing on a federal court decision addressing how “strength” should be defined for products with the same concentration but different volumes. The court adopted a broader FDA-based definition and dismissed False Claims Act allegations, but the absence of clear statutory or regulatory guidance leaves room for continued scrutiny and potential shifts in agency interpretation. Read the full article for key takeaways on how courts may approach undefined MDRP terms, how FDA regulations can influence rebate reporting obligations, and practical steps manufacturers can take to mitigate False Claims Act risk through consistent, well documented compliance practices.
