Medicare Advantage Fraud Enforcement Under a New Administration: Mitigating Risk for Criminal and Civil Actions

Erek Barron will be a panelist at the AHLA Institute on Medicare and Medicaid Payment Issues, taking place in Baltimore, MD from March 18-20, 2026. 

This session, "Medicare Advantage Fraud Enforcement Under a New Administration: Mitigating Risk for Criminal and Civil Actions," will cover the following issues: 

• The administration's focus on Medicare Advantage fraud and how they fit into agency priorities and the impact on providers
• DOJ enforcement actions in this area in the context of civil enforcement trends. The most recent Semiannual Report to Congress by HHS-OIG. HHS-OIG indicated in its report to Congress under the Trump Administration in June 2025 that it would continue to investigate healthcare fraud, with a particular focus on Medicare Advantage in which it has identified "a high risk of fraud, waste, and abuse." By the time of this presentation, there will be another report out and we will evaluate and compare how it discusses Medicare
• Advantage risk adjustment program. Will it still be as a high risk of fraud and abuse?
• The past year's settlements, lawsuits and known takedowns after HealthSun, Poehling, Anthem, Kaiser, and others
• Best practices for health care companies involved in Medicare Advantage to remain compliant in the face of increased scrutiny and mitigate risk
• Offer predictions regarding future enforcement in this space