Health Care Law

The second quarter of 2026 produced the largest health care fraud enforcement action in the government's history. On June 24, the Department of Justice announced the 2026 National Health Care Fraud Takedown: 455 defendants, including 90 physicians and other licensed professionals, charged across 56 federal districts in schemes involving more than $6.5 billion in alleged fraud. It has been covered thoroughly. What is less covered, and what we aim to focus on in this series, is the steady stream of self-disclosures and other enforcement activity that OIG publishes—yielding insights into current risk areas for health care organizations.

Our OIG enforcement dashboard has been updated through Q2 2026. In Q2, OIG resolved 27 self-disclosure settlements totaling $9.6 million. The median settlement was $80,000, and 19 of the 27 came in under $200,000. Seventeen related to screening and licensure: the provider either employed an individual excluded from federal health care programs or billed for services furnished by someone who was not properly licensed. These are administrative failures, and the organizations that reported them found the problem themselves and disclosed it to proactively resolve liability.

OIG posted 79 health care criminal and civil actions in Q2, accounting for roughly $2.87 billion. Six cases, each over $100 million, made up $2.29 billion of that, about 80 percent.

Two Q2 resolutions fit neither pattern, and they involve ordinary business arrangements rather than fraud schemes. Security Health Plan of Wisconsin self-disclosed and paid $1.3 million to resolve allegations that compensation paid to third-party agents for Medicare Advantage enrollment exceeded fair market value. Separately, the government reached a $1 million settlement over waived pharmacy copayments. Neither began as a scheme. Both began as decisions about how to structure compensation or handle patient balances, the kind of decision a business team makes and that often never reaches compliance until it has been running for years.

The advisory opinions point the same direction. OIG issued ten in Q2, eight favorable and two unfavorable. Both unfavorable opinions involved payments running toward referral sources: an orthopedic device manufacturer's consulting agreements with physicians (AO 26-10), and a home health agency’s payments to a vendor for online referral management software (AO 26-15). Neither consulting agreements nor referral software are prohibited. But when payment tracks proximity to referrals, the arrangement needs careful analysis and effective safeguards.

On June 30, the owner of a group of telemedicine companies, who had also written books on health care compliance, was sentenced for a $136 million Medicare fraud scheme.

Closing Thoughts

• Exclusion and licensure screening produced more Q2 self-disclosure settlements than every other theory combined. Monthly screening of employees, contractors, vendors, and medical staff, with contemporaneous documentation of each check, remains the highest yield control a provider can run.
• The quarter's most instructive settlements arose from arrangements that looked like business decisions rather than compliance problems: agent compensation, copayment waivers, vendor fees that moved with referrals. Keen organizations will ensure these arrangements are blessed by compliance before they are signed.
• Every one of those 27 settlements began with a provider finding its own problem. Identifying an overpayment starts the 60-day clock, and the decision whether to disclose should be made deliberately and documented either way, including the decision not to.