By: Christopher Parrella, Esq., CPC, CHC, CPCO
Parrella Health Law, Boston, MA
A Health Care Provider Defense and Compliance Firm

On May 12, 2025, the U.S. Department of Justice (DOJ) unveiled a sweeping new strategy memo titled “Focus, Fairness, and Efficiency in the Fight Against White-Collar Crime.” While the memo has broad application across U.S. business sectors, its implications for the health care industry are particularly acute.

Whether you’re in health care or a provider, facility, executive, vendor, or investor, this new directive is your wake-up call.

A Sharpened Focus on Health Care Fraud

DOJ made it clear: health care fraud is now among the DOJ’s top white-collar enforcement priorities. Health care fraud is grouped with other national threats like sanctions violations, fentanyl trafficking, and financial schemes by foreign adversaries.

The DOJ’s memo specifically targets:

• Fraud against federal health programs like Medicare and Medicaid.
• Improper billing for medically unnecessary services.
• Fraud involving provider-based billing, physician compensation, and misuse of electronic health records.
• Opioid-related violations, including fraudulent prescribing and marketing practices.
• Misconduct by health care companies that provide material support to foreign terrorist organizations, especially newly designated cartels and transnational criminal organizations.

If you’re a health care organization that receives federal funds or contracts with a government payer, you’re in the DOJ’s enforcement crosshairs.

Corporate Cooperation Expectations Just Got Higher

Health care entities hoping to avoid prosecution through cooperation must now meet stricter thresholds. DOJ reiterated its expectation that organizations must:

• Self-disclose wrongdoing early and voluntarily.
• Cooperate fully with investigators.
• Remediate misconduct, which includes firing culpable employees, improving compliance programs, and making restitution.

In a notable shift, the DOJ has streamlined the process for reviewing compliance monitorships and corporate resolutions. Monitors will only be imposed when absolutely necessary, and DOJ prosecutors are being directed to avoid protracted, burdensome investigations.

Faster, Leaner Investigations

Gone are the days of sprawling investigations that drag on for years without resolution. The memo directs prosecutors to move swiftly and decisively, making clear charging decisions, especially in cases involving:

• Individual actors
• Financial harm
• Obstruction of justice

This is particularly relevant for smaller practices and outpatient centers—do not assume you are too small to be noticed. The DOJ is prioritizing “demonstrable loss” and misconduct involving “senior-level personnel.”

If you’re billing Medicare or Medicaid and ignoring compliance obligations, you’re fair game.

Revised Whistleblower Incentives

For the first time, the DOJ’s whistleblower pilot program has been updated to offer monetary awards in newly prioritized enforcement areas, including:

• Corporate procurement fraud
• Controlled substances violations by health care entities
• Material support of terrorism through corporate contracts
• Health care companies enabling cartel or TCO operations

Translation: DOJ is actively encouraging insiders to report violations, particularly in health care.

What Parrella Health Law Recommends

1. Conduct a Compliance Stress Test
   Review your policies and practices against the DOJ’s stated enforcement priorities. Focus on billing accuracy, prescribing patterns, physician arrangements, and data protection.
2. Get Ahead of Cyber Vulnerabilities
   Cybersecurity is now firmly in the DOJ’s white-collar wheelhouse. If you haven’t performed a HIPAA risk analysis or implemented adequate controls, now is the time.
3. Prepare for Whistleblowers
   Build a transparent internal reporting mechanism and take all complaints seriously. DOJ is actively incentivizing current and former employees to come forward.
4. Avoid “Check-the-Box” Compliance
   DOJ is warning providers not to rely on symbolic resolutions or shell compliance programs. Invest in substantive, auditable, and meaningful compliance systems.

If you are a health care provider or executive and want help assessing how this new DOJ policy could impact your organization, we’re here to help.

Call Parrella Health Law today at 857.328.0382 or email Chris directly at cparrella@parrellahealthlaw.com.

You don’t need to wait for a subpoena to take your compliance seriously. The time to act is now.