Medicare Advantage Fraud Enforcement in 2026: What Recent Settlements Reveal About the Limits of Data-Driven False Claims Act Cases

Over the last several months, there has been no shortage of commentary about the Department of Justice’s (DOJ) Fraud Oversight through Careful Use of Statistics (FOCUS) initiative and the rise of data-driven False Claims Act (FCA) investigations. DOJ has made clear that it is increasingly interested in sophisticated analytics, statistical models, and "data miner" relators who use large public datasets to identify potential fraud.