Federal Health Care Fraud Program Reports $6.9 Billion in Civil Settlements for 2025, Nearly Four Times 2023's Total, as New Criminal Probes Dipped

The federal program that pays for Medicare and Medicaid fraud enforcement reported more than $6.9 billion in civil health care fraud settlements and judgments under the False Claims Act in fiscal year 2025, according to a fact sheet the Department of Health and Human Services Office of Inspector General (HHS-OIG) posted on Wednesday, Oct. 28.

The fact sheet summarizes the Health Care Fraud and Abuse Control (HCFAC) program, which the Justice Department and HHS run jointly under the Health Insurance Portability and Accountability Act of 1996. That law requires the two departments to report each year on the program's results, including the money returned to the Medicare trust funds.

Health Care Fraud Settlements Top $6.9 Billion

The $6.9 billion figure is nearly four times the total in the program's last full annual report posted by HHS-OIG, for fiscal 2023, which said civil health care fraud settlements and judgments under the False Claims Act "exceeded $1.8 billion" that year.

The new fact sheet also says the program returned $3.20 for every $1.00 spent over fiscal years 2023 through 2025. The fiscal 2023 report put the three-year return for 2021 through 2023 at $2.80 for every $1.00, and said that figure was still being pulled down by pandemic-era court closures and slowed enforcement.

The fact sheet does not list which cases produced the 2025 total or say whether the number was calculated the same way as before. The fiscal 2023 report said its figure counted only federal settlements and judgments, not state Medicaid money recovered in joint federal-state settlements.

Criminal Case Counts Compared With 2023

According to the fact sheet, the Justice Department opened more than 741 new criminal health care fraud investigations in fiscal 2025, compared with more than 802 in fiscal 2023. More than 448 defendants were convicted of health care fraud-related crimes, compared with more than 476 in 2023.

Prosecutors filed criminal charges in more cases than in 2023: over 382 cases involving at least 601 defendants, up from over 346 cases and at least 530 defendants.

HHS-OIG investigations led to 622 criminal actions in fiscal 2025, down from 651, and 861 civil actions, up from 733. HHS-OIG excluded 2,837 individuals and entities from Medicare, Medicaid and other federal health programs, up from 2,112 in 2023.

The fact sheet says FBI efforts disrupted more than 356 criminal fraud organizations and dismantled more than 79 enterprises. The fiscal 2023 report listed over 620 disruptions and more than 127 enterprises dismantled.

The fact sheet warns that its criminal case and defendant figures reflect what participating U.S. attorney's offices reported and "may not include matters handled exclusively by the Criminal Division's Fraud Section." It adds: "Figures may also vary because of differences in reporting methodologies."

Full Report Not Posted

As of Wednesday afternoon, HHS-OIG's list of HCFAC reports showed the fiscal 2025 fact sheet and full annual reports through fiscal 2023. It did not include a full report for fiscal 2025 or any report for fiscal 2024. The fiscal 2023 report was issued in December 2024, and the fiscal 2022 report in July 2023.

The full annual reports have usually included program spending, deposits to the Medicare trust funds and case summaries. The two-page fact sheet includes none of those details.

Sources: HHS Office of Inspector General, "Health Care Fraud and Abuse Control Program Report Fact Sheet (Fiscal Year 2025)," OIG-HCFAC-FS-2025, posted Oct. 28, 2026 (PDF): https://oig.hhs.gov/documents/hcfac/11958/FY_2025_HCFAC_Annual_Report_Fact_Sheet.pdf ; HHS-OIG report page: https://oig.hhs.gov/reports/all/2026/health-care-fraud-and-abuse-control-program-report-fact-sheet-fiscal-year-2025/ ; HHS-OIG list of HCFAC reports: https://oig.hhs.gov/reports/all/?report-type=HCFAC&hhs-agency= ; HHS and DOJ, Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2023 (December 2024) (PDF): https://oig.hhs.gov/documents/hcfac/10087/HHS%20OIG%20FY%202023%20HCFAC.pdf ; Cover photo: Hubert H. Humphrey Building, Washington, D.C. (Carol M. Highsmith, Library of Congress, public domain, via Wikimedia Commons)