HHS OIG Expected to Shift Focus “From Administrative Oversight to Criminal Accountability”

The U.S. Department of Health and Human Services’ Office of Inspector General (HHS OIG) recently announced that former U.S. Attorney Scott Brady has joined the Office to assist with its efforts to combat fraud in all segments of the federally funded healthcare industry. A report published shortly after the announcement indicates that Brady’s hiring, “reflects a strategic posture shift . . . from administrative oversight to criminal accountability.”

This aligns with HHS OIG’s own statements. For example, in its January 22, 2026 announcement, HHS OIG quotes Secretary Robert F. Kennedy, Jr. as stating:

“Ending fraud and abuse across HHS programs is one of my top priorities . . . . Every year, fraudsters and criminal schemes steal tens of billions of dollars from American taxpayers. That ends now. That’s why President Trump and I appointed a U.S. Attorney to lead this effort.”

HHS OIG also writes that Brady, the former U.S. Attorney, “will focus on the HHS-wide initiative to combat fraud,” and quotes Brady as stating, “I am excited to . . . build and mobilize the most powerful anti-fraud task force in HHS history. The day of reckoning for these criminals is here.” Brady was also responsible for the creation of the national COVID Fraud Task Force, and prosecuting healthcare providers and related entities for pandemic-era fraud remains among HHS OIG’s and the U.S. Department of Justice’s (DOJ) top priorities in 2026.

HHS OIG’s New Focus on Enforcement “Raises the Stakes on Compliance Risk”

As reported by HIT Leaders & News on January 26, 2026, HHS OIG’s focus on enforcement, “raises the stakes on compliance risk, particularly with Medicaid, Medicare, opioid-related prescribing, and COVID-era relief programs.” The well-written piece also notes that while HHS OIG has traditionally relied on auditing and civil penalties to enforce compliance, “centraliz[ing] criminal legal expertise within the agency . . . signals intent to pursue fraud not only as a compliance lapse, but as a felony offense deserving of federal indictment.”

The report also correctly notes that, “[t]his approach is not without precedent.” The DOJ has aggressively pursued criminal enforcement within the federally funded healthcare sector in recent years—including specifically in cases involving Medicare fraud, Medicaid fraud, opioid prescription fraud, and fraud under pandemic-era programs.

However, with HHS OIG taking on a direct criminal enforcement role, for entities suspected of engaging or participating in fraud, the risk of facing criminal prosecution is likely to become both greater and more immediate. Going forward, those facing scrutiny from HHS OIG will need to quickly discern whether this scrutiny is civil or criminal in nature—and they will need to build their defense strategies accordingly.

Potential Criminal Enforcement Risks in HHS OIG Investigations

With this in mind, while facing scrutiny from HHS OIG has always presented risks for healthcare providers participating in Medicare, Medicaid, and other federal programs, executives and administrators must now think even more carefully about how they approach both compliance and enforcement defense. This is particularly (but not exclusively) true in HHS OIG’s identified priority enforcement areas:

• Medicare Fraud – Medicare fraud costs U.S. taxpayers tens of billions of dollars annually. While we have seen the DOJ aggressively pursue criminal enforcement in Medicare fraud cases in recent years, going forward we expect HHS OIG to join in these efforts. With HHS OIG having direct access to data collected through both Medicare billing submissions and Medicare audits, this potentially removes a layer from the criminal enforcement process in these cases.
• Medicaid Fraud – The same is true in cases involving suspected instances of Medicaid billing fraud. Medicaid fraud has come under the microscope recently, particular with regard to acute care, child care, and family assistance. Medicaid fraud is also a multi-billion-dollar problem, and HHS OIG and the DOJ have both made clear that exposing and prosecuting all forms of Medicaid fraud is going to be a priority in the months and years ahead.
• Opioid Prescription Fraud – Opioid prescription fraud is another longstanding HHS OIG and DOJ enforcement priority. According to HHS OIG, Brady, the Office’s newly appointed former U.S. Attorney, “prosecuted . . . more medical professionals for opioid diversion than any other U.S. Attorney’s Office in the nation.” This background was undoubtedly among the key factors that led to Brady’s appointment, and we expect to see a high level of enforcement activity in this area as well.
• COVID-Era Fraud – Even though it has now been years since the end of the COVID-19 pandemic, HHS OIG and the DOJ are continuing to target pandemic-era fraud. This includes (but is not limited to) fraud involving program billings for COVID-19 testing, treatment, and vaccination, as well as fraud under programs like the Paycheck Protection Program (PPP) and Employee Retention Credit (ERC). Reports suggest that federal authorities have a substantial backlog of cases in this area that they plan to continue pursuing well into the future.

To be clear, while these are among HHS OIG’s stated enforcement priorities, these are not the only enforcement risks that healthcare providers and other entities will face in 2026 and beyond. From fraud involving other federal programs to Anti-Kickback Statute and Stark Law violations, we expect to see HHS OIG-led prosecutions involving a wide range of other violations as well.  

Key Risk Mitigation Strategies for Healthcare Providers and Other Entities Going Forward

With these risks in mind, what can (and should) healthcare providers and other entities do to mitigate their risk going forward? Among other critical steps, professionals and organizations that are subject to HHS OIG’s oversight should:

1. Conduct a Comprehensive Federal Compliance Assessment

All entities that are subject to HHS OIG’s oversight need to have a clear and comprehensive understanding of their compliance-related risk. This requires an understanding of both: (i) the entity’s federal compliance obligations; and, (ii) any compliance failures that present immediate risks for civil or criminal enforcement.

Gaining this understanding involves conducting a comprehensive federal compliance assessment. Entities that bill Medicare, Medicaid, and other federal healthcare programs must ensure that their patient and billing practices are fully compliant with all applicable laws and regulations. Likewise, all entities must ensure that their prescribing, referral, and other day-to-day practices are capable of withstanding federal scrutiny.

2. Establish Internal Audit Response Protocols

Even fully compliant entities are at risk of facing audits scrutinizing Medicare and Medicaid billings. As a result, along with implementing comprehensive and custom-tailored compliance programs, entities that bill Medicare and Medicaid should also implement internal audit response protocols.

When facing a Medicare or Medicaid audit, an effective response is essential. Targeted entities must be prepared to affirmatively demonstrate compliance using documentation they have on hand. If an entity cannot produce documentation of compliance during an audit, this will lead to a presumption of noncompliance; and, depending on the circumstances, this could in turn lead to an HHS OIG investigation.

3. Develop an Internal Plan for Responding to HHS OIG Scrutiny

Along with preparing for the possibility of facing Medicare and Medicaid audits, entities that bill these programs (among others) must also be prepared for the possibility of facing additional scrutiny from HHS OIG. As discussed above, this scrutiny is expected to intensify, with criminal enforcement being a top priority.

Preparing for the possibility of facing an HHS OIG investigation involves establishing appropriate internal policies, procedures, and protocols. These include policies for document retention, procedures for assembling an internal response team, and protocols for engaging outside defense counsel. When facing federal investigations, healthcare providers and other entities need to be absolutely certain that they are not making mistakes or oversights that have the potential to lead to unnecessary consequences.

4. Monitor and Document Compliance On an Ongoing Basis

Managing federal compliance is an ongoing process. With this in mind, after assessing their federal compliance obligations, healthcare providers and other entities must continue to monitor and document compliance on an ongoing basis. Not only is this critical for avoiding compliance failures, but it is also critical for ensuring that entities have the documentation on hand to successfully defend against audits and investigations.

Monitoring compliance involves conducting periodic internal audits, among other steps. Documenting compliance involves keeping records of these audits, as well as employee training programs and other internal compliance-related activities. These are all of equal importance.

5. Proactively Resolve Past Billing Errors and Other Violations

Finally, if an organization’s internal compliance assessment reveals past billing errors or other violations, it will be important to take appropriate steps to resolve these issues proactively. Ignoring known compliance errors can increase organizations’ (and their executives’ and administrators’) risk of facing criminal fraud allegations.

The steps that healthcare providers and other entities need to take to proactively resolve past violations depend on the specific circumstances involved. In all cases, however, time is of the essence, and executives and administrators must ensure that they are making informed decisions as quickly as possible.

Schedule a Call with the Federal Healthcare Compliance and Defense Team at Oberheiden P.C.

If you have questions (or concerns) about HHS OIG’s efforts to prioritize compliance enforcement in 2026 or beyond, we invite you to get in touch. Call 888-680-1745 or contact us online to schedule a call with the federal healthcare compliance and defense team at Oberheiden P.C.