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

Erek Barron participated as a panelist at the AHLA Institute on Medicare and Medicaid Payment Issues, held March 18–20, 2026, in Baltimore, Maryland.

During the session, “Medicare Advantage Fraud Enforcement Under a New Administration: Mitigating Risk for Criminal and Civil Actions,” the panel addressed:

• The administration’s focus on Medicare Advantage fraud, how this priority aligned with agency enforcement agendas, and the impact on providers.
• Recent DOJ enforcement actions in the context of broader civil enforcement trends.
• Findings from the HHS-OIG Semiannual Reports to Congress, including a comparison of how Medicare Advantage risk adjustment was characterized under the Trump administration in June 2025 and in the most recent report.
• Notable settlements, lawsuits, and enforcement actions over the past year, including matters involving HealthSun, Poehling, Anthem, Kaiser, and others.
• Best practices for Medicare Advantage organizations to remain compliant amid heightened scrutiny and mitigate enforcement risk.
• Predictions regarding future enforcement trends in this space.