DOJ Issues Final Rule Establishing National Fraud Enforcement Division

On August 18, 2026, the Department of Justice (DOJ) issued a final rule formally establishing the National Fraud Enforcement Division (the Division). Issued after months of press about a major realignment of existing DOJ resources, the final rule amends DOJ organizational regulations to set forth the authorities of the Division. This follows the Division’s August 13, 2026, memorandum detailing its enforcement priorities, which focus on healthcare fraud as a central priority. The Division highlighted that it intends to deploy advanced data analytics to proactively identify fraudulent schemes in telemedicine, Medicare and Medicaid billing, controlled substance diversion, and home health and hospice programs. The Division will also work to investigate and prosecute companies and individuals engaged in deceptive marketing of unsafe healthcare products and services.

The Final Rule 

The final rule sets forth the powers and functions delegated to the Division. The Division’s authorities include the power to handle numerous criminal fraud proceedings, including:

• Criminal matters involving criminal frauds;
• Criminal violations of the internal revenue laws;
• Criminal trade fraud (including imports, customs, and foreign commerce);
• Criminal proceedings involving monies owed to or paid by the United States;
• Criminal proceedings involving fraud or abuse with respect to health plans; and
• Criminal health care fraud and controlled substances distribution and diversion schemes. 

One carve-out to the Division’s broad enforcement authority is criminal antitrust conspiracies to defraud the United States, over which the Antitrust Division will retain control. Despite that carve-out, the Division is empowered with a diverse array of enforcement tools, including the authority to seek injunctions against fraud, obtain restitution, seize property, and impose and recover penalties. In addition, the final rule allows the Division to exercise functions relating to the certification of special grand juries and legal proceedings against persons suspected of being involved in organized criminal activity. Finally, the final rule authorizes the Division to handle “any case or category of cases as the Attorney General or Deputy Attorney General may assign.”  

Implications 

The Division’s mission to zealously investigate and prosecute criminal fraud against the federal government—combined with its broad authority, data reliance, and proactive approach—signals increased scrutiny and enhanced enforcement against health care providers. Uncertainty is also on the horizon because the final rule empowers the Division with unspecified authority to handle cases assigned to it by the Attorney General. In adapting to this enforcement landscape, providers should continually monitor billing and coding practices, with particular focus on data analytics (just as the Division is doing), to identify outliers and correct any inaccurate coding and billing irregularities. 

Reporter, Doug Comin, Atlanta, GA, +1 404 572 3525, [email protected]

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Editors: Chris Kenny and Ahsin Azim

Issue Editors: Taylor Whitten and Hamilton Craig