Health Care Enforcement Under Trump 2.0: Leadership Shakeups and Shifting Priorities — EnforceMintz

Department of Justice (DOJ)’s health care enforcement is shifting under Trump, with leadership changes and new policy-driven priorities alongside traditional False Claims Act (FCA) actions targeting fraud and kickbacks.

KEY POINTS:

• Leadership turnover is reshaping enforcement. DOJ and HHS experienced unprecedented departures of senior leaders and career attorneys in 2025, raising questions about enforcement capacity and signaling potential increases in declinations or dismissals of FCA cases.
• Enforcement priorities are becoming politicized. New DOJ memoranda reveal a shift toward policy-driven FCA enforcement, targeting areas like DEI practices and gender-affirming care, alongside traditional priorities such as Medicare Advantage fraud and kickbacks.
• Traditional fraud enforcement remains strong. Despite leadership changes, DOJ continues to pursue familiar schemes involving opioids, telemedicine, genetic testing, and Medicare Advantage fraud.
• Unpredictability is expected in 2026. The combination of political priorities, leadership shakeups, and persistent fraud enforcement suggests an unpredictable enforcement landscape, with continued judicial scrutiny of novel theories and aggressive prosecution of health care fraud.

This article is part of EnforceMintz: Healthcare Enforcement Trends in 2025 & 2026 Outlook, a series exploring key developments and practical strategies for health care organizations navigating enforcement risks. Read more articles from EnforceMintz to stay current on enforcement trends and compliance strategies.

While the DOJ saw unprecedented turnover and changes in leadership in 2025, FCA investigations involving the health care industry mostly focused on traditional areas such as Medicare Advantage fraud and kickbacks. But political priorities began to emerge in this traditionally apolitical context with the pursuit of providers involved in gender-affirming care. Personnel changes and reframed priorities reflect disruption and recalibration in enforcement strategy beyond the expected changes accompanying a transition in leadership.

Changes in Key Health Care Enforcement Personnel

Roughly one-third of senior leaders reportedly have left DOJ since the start of the new administration, and Civil Division leadership was not immune from that shakeup. Michael Granston — a near 30-year veteran of DOJ who had overseen FCA investigations and litigation for many years — left his post in May 2025. Granston was the Civil Division’s highest-ranking career employee, known for his tough but fair-minded approach to FCA enforcement and his willingness to meet with defendants who wished to be heard. Under Granston’s watch, the Civil Division articulated principles guiding the government’s decision making in seeking dismissal of a qui tam case and published policy guidance on providing credit in FCA settlements to corporations for “disclosure, cooperation, and remediation.” Brenna Jenny, Deputy Assistant Attorney General for the Commercial Litigation Branch of the Civil Division, now oversees FCA enforcement.

Impact of Widespread Vacancies

Turnover in political appointees at federal agencies such as DOJ is common when a new administration takes over, but DOJ and US Attorney’s Offices across the country experienced an unprecedented exodus of career attorneys in 2025. Widespread vacancies persist, which raises questions about DOJ’s capacity to handle the large volume of FCA cases that are typically pending at any given time. This situation could, among other things, lead to an increase in declinations and even dismissals.

HHS OIG Leadership Changes

Like DOJ, the Office of Inspector General for the Department of Health & Human Services also experienced turnover in important positions. 

• Inspector General Christi Grimm was dismissed in January 2025, along with other Inspectors General. Grimm’s firing came as no surprise given that President Trump targeted her during his first term after she published a report related to COVID-19 test kit and PPE shortages with which he disagreed.
• The Senate Finance Committee only recently voted to advance the nomination of President Trump’s replacement pick, Thomas Bell (sworn in on December 22, 2025). 

Reframing of DOJ’s Enforcement Priorities

Historically, DOJ rarely articulated its FCA or other enforcement priorities in formal memoranda, but this administration seems to be prioritizing transparency in this regard, as evidenced by two significant memoranda published earlier this year.

On May 12, 2025, Matthew Galeotti, the new head of DOJ’s Criminal Division, released a memo addressing enforcement priorities and a variety of policies (Criminal Division Memo). The Criminal Division Memo focused on the familiar priority of preventing fraud, waste, and abuse, including health care fraud, and doubled down on the Biden administration’s policy of encouraging self-disclosure. More details regarding this memo can be found here.

Similarly, on June 11, 2025, Brett Shumate, the new head of DOJ’s Civil Division, published a memo detailing his division’s enforcement priorities (Civil Division Memo). Shumate noted at the outset that “President Trump and Attorney General Bondi have directed the Civil Division to use its enforcement authorities to advance the Administration’s policy objectives,” which underscored the fact that DOJ has deviated from its traditional practice of operating independently of the administration.

The Civil Division Memo is notable for what it said and what it did not say about enforcement priorities. It articulated novel, policy-driven uses of the FCA, such as combatting discriminatory (i.e., DEI-related) practices and policies, ending antisemitism, and protecting women and children. The latter refers to DOJ’s intent to pursue FCA and Food, Drug, and Cosmetic Act (FD&C Act) violations related to the provision of gender-affirming care. Many in the health care industry were surprised that the Civil Division memo did not mention recent areas of FCA enforcement focus, such as cybersecurity fraud, pandemic-related fraud, and other types of health care fraud. DOJ’s new areas of focus are particularly surprising given that they — unlike cybersecurity, pandemic-related, and health care fraud — bear no relationship to the underlying purpose of the FCA, which is to protect the public fisc.

A subsequent DOJ announcement supplemented the Civil Division Memo with some more familiar enforcement priorities. Soon after Brenna Jenny’s arrival, DOJ announced the creation of a “new” False Claims Act Working Group (FCA Working Group) consisting of personnel from HHS, DOJ’s Civil Division, and the Centers for Medicare & Medicaid Services (CMS). This initiative seems to be a relaunch of a similar, if not identical, group created in 2020. While little is known about the activities of the original group, the press release announcing the FCA Working Group provided some interesting details regarding its focus, including the following “priority enforcement areas”:

• Medicare Advantage;
• drug, device, or biologics pricing;
• barriers to patient access to care;
• kickbacks related to products reimbursable by federal health care programs;
• materially defective medical devices impacting patient safety; and
• manipulation of electronic health records systems to drive inappropriate utilization of products and services covered by Medicare.

Not enough time has passed for DOJ to execute fully on its articulated enforcement priorities, but 2025 enforcement actions suggest that DOJ will continue to advance enforcement in traditional priority areas as well as novel ones.

Several Medicare Advantage–related developments suggest that DOJ will continue to pursue this long-standing enforcement priority. For example, a March 2025 settlement detailed a familiar scheme: submission of false diagnosis codes by a physician group to increase Medicare Advantage (MA) payments. While most 2025 settlements likely involved qui tam cases filed well before President Trump took office and thus may not indicate current priorities, decisions to intervene should be viewed differently. A May 2025 complaint alleging kickbacks paid by three of the nation’s largest health insurers to three large insurance broker organizations strongly signals this administration’s continued interest in enforcement related to MA fraud, but the Boston US Attorney’s Office is known for its activism in health care fraud cases and could be leading the charge.

The June 2025 National Health Care Fraud Takedown (the Takedown) also reflected enforcement in familiar areas through familiar means. As in past years, the Takedown targeted fraud involving opioids, telemedicine, genetic testing, durable medical equipment, pandemic relief programs, and health care fraud schemes involving medically unnecessary testing or kickback arrangements. “Operation Gold Rush,” announced in tandem with the Takedown, similarly focused on familiar fraud tactics: use of stolen or deceitfully obtained beneficiary information to fraudulently bill for medically unnecessary testing and durable medical equipment.

Notably, the Takedown announcement emphasized CMS’s prevention of $4 billion from being paid in response to false or fraudulent claims and CMS’s suspension or revocation of billing privileges of hundreds of providers prior to the Takedown. CMS Administrator Dr. Oz credited advanced data analytics, real-time monitoring, and swift administrative action as enabling CMS to stop fraud before it happened. Moving forward, CMS will partner with DOJ’s Civil Division and other members of the FCA Working Group to consider payment suspensions pursuant to a federal regulation allowing this measure in response to a credible allegation of fraud. We expect to see continued use of this tool to proactively thwart fraud attempts.

At least one enforcement initiative marks an abrupt departure from past practice and demonstrates that DOJ intends to use its enforcement authorities to advance the administration’s policy objectives. In July 2025, DOJ announced that it had sent more than 20 subpoenas to providers involved in performing transgender medical procedures on children. It is unusual for DOJ to announce the issuance of subpoenas to entities under investigation; typically such proceedings are confidential.

In one such case, DOJ subpoenaed 15 categories of records from a hospital, including names and health records of children receiving gender-affirming care. DOJ sought these records on the theory that distribution of a misbranded or unapproved drug in violation of the FD&C Act occurs when a provider prescribes or administers an approved drug (e.g., puberty blockers) for an unapproved indication (e.g., gender dysphoria treatment). A US District Court judge in the Eastern District of Pennsylvania disagreed. Off-label prescribing and administration of puberty blockers to children with gender dysphoria is lawful in Pennsylvania, and clinicians are free to exercise their professional judgment to prescribe FDA-approved drugs for off-label use.

Takeaways

The departure of seasoned apolitical leaders and line attorneys from DOJ could make it easier for the Trump administration to pursue its political priorities through health care fraud enforcement actions. We expect continued judicial scrutiny of novel theories in support of politicized enforcement objectives, especially those in tension with state laws or the fundamental purpose of the FCA, which is to protect the public fisc. If we can make any prediction, it is that 2026 is likely to be unpredictable. Still, as we have said before, one thing is constant: the government remains committed to prosecuting criminal and civil health care fraud.

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The next edition of EnforceMintz — our annual False Claims Act Statistical Year In Review — will analyze trends in FCA cases using data from DOJ’s recently released annual report on FCA settlements and judgments.

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