February 3, 2026
False Claims Act recoveries broke records in 2025. We anticipate another strong year in 2026. We are looking at enforcement trends and keeping our eyes on some potential headwinds. In our twenty-fourth year of representing whistleblowers, we are optimistic, buoyed by the FCA’s steady track record of producing results. But we are also mindful that the success of the FCA in any one year depends on many factors. Here is what we are paying attention to in 2026.
Pronouncements by Department of Justice officials at recent conferences, along with DOJ’s recent 2025 announcement of FCA recoveries, and recent settlements, highlight the following enforcement areas to watch.
Medicare Advantage, or Medicare “Part C,” is a part of Medicare in which private insurers contract with the government to manage the care of Medicare beneficiaries. It now accounts for over half of all Medicare beneficiaries. After years of whistleblowers alerting the government to fraud in these plans, the government has focused and settlements are following. Some major cases were or are being litigated. We explain this area and the ongoing enforcement efforts here. Our firm is recognized as an industry expert in this area. WLC partner Erica Hitchings recently spoke on the topic.
One of the 2025 cybersecurity settlements highlighted by DOJ involved MORSECORP, Inc. paying $4.6 million, plus interest, to resolve a qui tam matter brought by one of our clients. It was alleged that MORSECORP made false representations concerning compliance with required cybersecurity controls for safeguarding sensitive government information. This settlement is particularly notable because it represents the first major False Claims Act settlement with a defense contractor based on failures to implement required cybersecurity controls.
In May 2025, WLC partner Bruce Judge was selected as one of Lawdragon’s 500 Leading Global Cyber Lawyers. Notably, Mr. Judge is the only attorney from a whistleblower firm to receive this distinction. He is an industry expert in this area and was the keynote speaker at the CS2 Conference in Virginia.
In 2025, the Ninth Circuit Court of Appeals ruled that customs fraud cases may be brought in federal district court and can trigger FCA liability. Shortly thereafter, DOJ announced a cross agency Trade Fraud task force. Then in December, DOJ announced its largest ever customs fraud settlement in a case brought by a whistleblower. We have successfully represented trade fraud whistleblowers and expect whistleblowers will continue to play a critical role in protecting U.S. trade laws and taxpayer dollars.
Over the past year, wound care has emerged as a federal health care enforcement priority, with both DOJ and the Centers for Medicare & Medicaid Services (CMS) signaling heightened scrutiny of billing practices in this area through coordinated regulatory and enforcement action. In November 2025, CMS revised its reimbursement approach for skin substitutes, replacing payment structures that had created outsized profit margins with standardized rates designed to reduce overutilization incentives.
For its part, DOJ reached major FCA settlements, including a $309 million settlement with Apex Medical, a $45 million settlement with Vohra Wound Physicians Management LLC, and DOJ’s National Health Care Fraud Takedown charged seven individuals in connection with $1.1 billion in fraudulent Medicare claims for skin substitutes. We expect continued robust enforcement activity and settlements in 2026.
DOJ appears to have renewed focused on pharmaceutical fraud, an area in which WLC has a strong track record. We foresee additional FCA cases in 2026 involving illegal kickbacks and rebates to prescribers, pharmacies, PBMs, and patients using scam “patient assistance charities.” We also see continued focus on FCA cases involving price manipulation and misreporting of Best Price and Average Manufacturer Price; formulary and prior‑authorization abuses under Part D; and the marketing of drugs for non‑covered or medically unnecessary uses.
Last year saw several large FCA verdicts and settlements involving pharmaceutical fraud. One of the largest pharmaceutical verdicts in history was against Omnicare/CVS in 2025. It involved the submission of tens of thousands of false claims to Medicare, Medicaid and Tricare for prescriptions whose refills had run out or expired.
Another noteworthy verdict came in the CVS Caremark case. This case shined a light on fraud in Medicare Part D. Medicare Part D is designed to partially cover the cost of providing prescription drug coverage to Medicare beneficiaries. It costs Medicare beneficiaries and the government over $130 billion per year. We explain this area, potential areas of fraud, and some of the ongoing enforcement efforts, including the judgment in U.S. ex rel. Behnke v. CVS Caremark, here.
In June 2025 DOJ announced its intention to use the FCA in new areas known as Administration policy objectives. These include “to enforce our longstanding civil-rights laws and to combat illegal private-sector DEI preferences, mandates, policies, programs, and activities” and gender-affirming care. This intention was reiterated when DOJ recently announced its 2025 FCA recoveries.
In 2025 over one-third of recoveries under the FCA came from cases in which the government did not intervene. Whistleblowers successfully pursuing meritorious cases on their own, and contributing substantially to FCA recoveries, continues a trend that began several years ago. One notable example in 2025 was the declined FCA qui tam case U.S. ex rel. Behnke v. CVS Caremark which resulted in a judgment of $95 million in single damages or $285 million after mandatory trebling under the FCA (in addition to statutory penalties). The case is on appeal to the Third Circuit Court of Appeals.
A number of cases challenging the constitutionality of the FCA’s qui tam provision are working their way through the courts. DOJ is committed to defending the constitutionality of a law that has returned over $85 billion to the U.S. Treasury since 1986. Litigating this issue is, however, draining government and whistleblower lawyer resources away from investigating and pursuing FCA cases.
We are concerned about the continuing loss of experienced federal law enforcement personnel, the diversion of remaining resources away from traditional FCA areas to the enforcement of DOJ’s “Administration policy objectives” noted above, and the constant specter of federal government shutdowns. The government’s increasing use of data and data mining cannot fully replace the need for adequate numbers of seasoned investigators and litigators.
A number of State Attorneys General’s offices are ramping up resources. In many cases, hiring former federal prosecutors. It remains to be seen how effectively the States can take up the slack. However, recent State FCA enforcement actions, such as the one against CVS, are encouraging. Other noteworthy state settlements include,
CVS Pharmacy’s 18.2 million settlement with the state of California. The settlement resolves allegations that CVS knowingly submitted improper reimbursement requests for prescriptions to California’s Medicaid program “Medi-Cal”.
In January 2025, Pfizer agreed to pay nearly $60 million to resolve federal and state False Claims Act allegations involving improper physician payments to induce prescriptions of the migraine drug Nurtec ODT.
In November 2025, Texas Attorney General Ken Paxton secured a $41.5 million settlement with Pfizer to resolve allegations that it manipulated drug testing and distributed an adulterated ADHD medication (Quillivant XR) to children covered by Texas Medicaid, in violation of the Texas Health Care Program Fraud Prevention Act.
The FCA has returned over $85 billion to the U.S. Treasury since 1986. FCA enforcement and recoveries have seen ups and downs over the years. Whistleblowers, however, have remained constant. Moreover, the FCA has a steady track record of producing results. While we are mindful of certain potential headwinds in 2026, we remain optimistic and committed to representing whistleblowers nationwide.