Healthcare fraud enforcement is hardly new. But when the Department of Justice tells the healthcare industry exactly where it intends to focus its resources, providers should absolutely pay attention.

In an August 13, 2026 memorandum, DOJ identified healthcare fraud as an enforcement priority and singled out several areas for increased scrutiny: telemedicine, Medicare and Medicaid fraud, home health and hospice, controlled-substance diversion, kickbacks, and deceptive marketing of healthcare products and services. What is particularly notable is not just what DOJ plans to investigate, but how it plans to find those cases. The Department specifically points to the expanded use of data analytics to identify potentially fraudulent activity. That means providers should assume that unusual billing, prescribing, referral, utilization, or reimbursement patterns can attract attention before anyone has reviewed an individual medical record or spoken to a patient.

For telemedicine providers, that is especially significant. The tremendous growth of telehealth has created legitimate new models of care, but it has also made telemedicine a recurring focus of federal enforcement. DOJ says it will use data to identify potentially exploitative telemedicine schemes, including those involving medically unnecessary services and prescriptions. The practical question for a telemedicine company should therefore not simply be whether its services are legitimate. It should also be: What does our data look like to the government? Prescribing volume, encounter length, geographic reach, utilization patterns, medical necessity, documentation, ordering practices, and relationships with pharmacies, laboratories, marketers, and other providers can all become part of the picture.

Home health and hospice providers are also squarely in DOJ's sights, particularly where the government believes elderly patients are being exploited. Eligibility determinations, certifications, utilization patterns, referral relationships, and documentation supporting the level of care provided are obvious areas for providers to examine now rather than after receiving a subpoena or investigative demand.

DOJ also specifically identifies the illegal prescribing and dispensing of opioids and other controlled substances as an enforcement priority. Providers, pharmacies, and organizations involved in prescribing or dispensing controlled substances should expect scrutiny not only of individual prescriptions, but of broader prescribing patterns, patient populations, clinical documentation, and financial relationships.

And then there are kickbacks—an issue that continues to surface across virtually every corner of healthcare. Arrangements involving physicians, pharmacies, laboratories, marketers, management companies, lead-generation businesses, and other referral sources deserve particular attention. A healthcare service can be medically necessary and actually provided, yet the financial arrangement surrounding the referral of that patient can still create serious federal exposure.

Another important point in the memorandum is the breadth of cases DOJ says it intends to pursue. The Department is looking not only at healthcare fraud itself, but also at related money laundering, tax offenses, and other financial crimes. In practice, that means an investigation that begins with billing, prescribing, or referrals may not stay there. Once investigators begin following the money, they may examine ownership structures, management fees, distributions, marketing payments, transfers between related entities, and other financial activity.

So What Should Healthcare Providers Be Doing?

The August 13 memorandum does not change the law. What it does is give the industry a fairly useful preview of the government's enforcement priorities. Providers operating in these areas should use that preview to examine their operations the way an investigator armed with claims data might look at it. Are there billing or prescribing patterns that stand out? Are telemedicine encounters documented well enough to support the care actually provided? Do home health or hospice records support eligibility and medical necessity? Are relationships with marketers, pharmacies, laboratories, physicians, management companies, and referral sources structured and documented appropriately? Do the company's marketing materials accurately describe what it does and how its services or products are used? And perhaps most importantly, do not wait for a government inquiry to discover the answer.

DOJ also reiterated the importance of voluntary self-disclosure, cooperation, and remediation when misconduct is identified. Whether disclosure is appropriate is a highly fact-specific legal decision, but identifying and addressing a problem internally generally gives an organization more options than discovering it for the first time in a government subpoena. For healthcare providers, the message from DOJ is unusually clear: these are the areas where the government intends to look. Providers would be wise to look there first.

MDRXLAW represents healthcare providers and healthcare businesses in government investigations, audits, regulatory enforcement matters, and healthcare fraud and compliance matters. We also work with providers proactively to identify and address regulatory risk before it becomes an enforcement problem.