DOJ Accelerates False Claims Act Enforcement: New Protocol Signals Faster Action on Benefits Fraud Whistleblower Cases

On May 27, the U.S. Department of Justice (DOJ) issued a memorandum announcing new procedures to accelerate its review and enforcement of False Claims Act (FCA) cases involving alleged fraud on federally funded benefits programs administered by states. These changes are designed to speed DOJ’s handling of whistleblower lawsuits in this area and channel government resources toward the largest, most complex, and most harmful fraud schemes. In fiscal year 2025, whistleblowers filed a record 1,297 FCA lawsuits — accounting for more than 78 percent of FCA recoveries that year. 

The memorandum follows the March 16 Executive Order “Establishing the Task Force to Eliminate Fraud,” which directed DOJ to promote meritorious qui tam actions and, to the maximum extent practicable, complete review of such matters within the 60-day period contemplated by the FCA statutory provisions. Consistent with that directive, DOJ’s new protocol is aimed at accelerating review of “benefits fraud” qui tams while preserving the government’s oversight and ultimate control of those cases. 

In practical terms, the protocol is intended to: (1) expedite screening and investigation of benefits fraud qui tams; (2) allow relators to assume primary responsibility for litigating certain cases, subject to DOJ oversight and control; (3) concentrate government resources on sophisticated actors responsible for the largest and most harmful fraud schemes; and (4) deploy civil, criminal, and administrative tools in a coordinated way. 

DOJ Sets Expedited Review Process for FCA Benefits Fraud Cases 

Under the FCA’s qui tam provisions, a private plaintiff (known as a “relator”) may file a fraud action in the name of the United States of America. The lawsuit is initially filed under seal and presented to DOJ for determination of whether the Government will elect to intervene in the suit. 31 U.S.C. § 3730(b). The statute provides for a 60-day window for DOJ to make that intervention determination; in practice, however, that window is typically extended for months—or, in many cases, years—while the Government conducts its investigation.

The new policy changes that. Under these new procedures, DOJ attorneys are directed to “prioritize” and “to the maximum extent practicable” complete their initial review of the suit within 60 days “but no later than 120 days” from receipt of the relator’s complaint. At the conclusion of that period, the Department must reach one of three determinations:  

1. Permit relator to proceed with the lawsuit (subject to government supervision and control); 
2. Conclude that further government investigation is warranted; or
3. Dismiss the qui tam under 31 U.S.C. § 3730(c)(2)(A) for lack of adequate specificity or legal deficiency. 

The compressed 60-to-120-day review timeline will likely result in a significant increase in declinations by the Government and an increase in relator-driven qui tam suits in the federal courts. That is particularly true in healthcare fraud cases, where complex billing data and complex regulatory schemes may make cases difficult to evaluate within this short window. Indeed, the policy recognizes as much, noting that “this protocol will increase the number of benefits fraud matters primarily litigated by relators.” 

When DOJ May Allow Qui Tam Relators to Lead Benefits Fraud FCA Litigation 

DOJ identifies several non-exclusive considerations that may support allowing a relator to proceed promptly with a benefits fraud case, while the government retains ongoing supervision and ultimate control: 

• Plausible FCA violation: The complaint describes conduct that, if true, would violate the False Claims Act.
• Corroborating evidence: The allegations are supported by data analytics, agency information, or the whistleblower’s insider knowledge.
• Straightforward scheme: The alleged misconduct is not novel or complex.
• Smaller potential damages: The potential damages are below $10 million.
• Aggravating circumstances: Aggravating factors are present, such as beneficiary harm, ongoing misuse of federal funds, or concealment or deceit by the defendant. 

The memorandum also makes clear that, when DOJ allows a relator to move forward quickly, it expects the whistleblower and counsel to be prepared to shoulder the obligations of the litigation. DOJ signals that complaints should be sufficiently detailed to satisfy pleading requirements and that the burdens and costs imposed on the government should be minimized to the greatest extent possible. Even in those cases, DOJ will continue evaluating whether to seek dismissal later if the allegations are not substantiated and pursuit of the matter is no longer in the government’s interest. 

What Companies Can Expect During Expedited DOJ FCA Investigations 

If DOJ determines that further investigation is appropriate, the memorandum calls for an expedited 120-day investigative period. During that period, counsel can expect DOJ to: 

• Develop an investigative plan that includes prompt issuance of Inspector General subpoenas and/or civil investigative demands (CIDs), as well as early witness interviews, while accounting for any covert investigation concerns.
• Use targeted requests for information tailored to the issues under investigation and consider early interviews or oral examinations as alternatives to some document demands.
• Set definitive response deadlines for subpoenas and CIDs and, absent a justifiable reason for noncompliance, pursue enforcement if those deadlines are not met.
• Consider requesting assistance from relator’s counsel where that could help expedite the investigation.
• Make intervention decisions when liability evidence and the general parameters of loss are established, with further refinement of damages occurring during discovery if a detailed damages assessment would unduly delay the investigation.
• Use supervisory case reviews at the end of the 120-day period, with any first extension requiring approval from the Deputy Assistant Attorney General of the Commercial Litigation Branch and any subsequent extension requiring approval from the Assistant Attorney General of the Civil Division.

DOJ’s Coordinated Civil, Criminal, and Administrative Enforcement Strategy

DOJ will take a coordinated, “whole‑of‑government” approach to benefits fraud matters, using multiple enforcement tools simultaneously:

• Criminal referrals: New benefits fraud matters will be promptly referred to the Criminal Division and/or the National Fraud Enforcement Division to evaluate potential criminal violations.
• Agency referrals: DOJ will share cases with affected agencies to consider administrative actions, including payment suspension.
• Data analytics: DOJ will use agency data and analytics to corroborate whistleblower allegations and identify patterns of fraud.

What This Means for Participants in Federally Funded Benefits Programs

• Faster government action: Entities participating in federally funded benefits programs should expect DOJ to move more quickly in assessing sealed qui tam allegations involving benefits fraud, potentially compressing the time available to prepare once a matter becomes active.
• More relator-driven litigation: DOJ may more frequently permit relators to take primary responsibility for litigating smaller, more straightforward benefits fraud matters, subject to continued government oversight and control.
• Targeted, accelerated investigations: When DOJ elects to investigate, recipients can expect targeted information requests, firm deadlines, and potentially quicker resort to subpoena or CID enforcement if deadlines are missed without justification.
• Parallel exposure across forums: A single qui tam can now more quickly trigger civil, criminal, and administrative scrutiny, including possible agency payment-suspension measures where appropriate.

Organizations and individuals participating in federally funded benefits programs should consider whether their compliance, reporting, and investigative-response processes are calibrated for a faster FCA review cycle. The memorandum signals shorter review periods, greater use of relator-driven litigation in appropriate cases, and closer coordination among civil, criminal, and administrative enforcement authorities. For healthcare-sector participants, these developments may be particularly significant where operations intersect with federally funded benefits programs administered by states.

For more on healthcare enforcement trends, see Barnes & Thornburg’s 2025 Healthcare Enforcement and Compliance Report, which covers FCA developments, enforcement trends, civil and criminal actions, industry guidance, and government policy updates.

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