On May 27, 2026, the U.S. Department of Justice (DOJ) issued new guidance to the Fraud Section of the Civil Division and assistant U.S. attorneys investigating False Claims Act (FCA) violations aimed at accelerating the government’s investigation and review of qui tam complaints alleging fraud on federally funded benefits programs administered by states (i.e., Medicaid, the Supplemental Nutrition Assistance Program, Temporary Assistance for Needy Families, etc.).
When a whistleblower files a qui tam complaint alleging FCA violations, the complaint is sealed for at least 60 days while the government investigates and decides whether to intervene. The government routinely seeks and obtains extensions, which sometimes result in seal periods lasting months or even years.
The new guidance accelerating DOJ’s review of these benefits fraud cases follows a directive in a March 2026 Executive Order from President Trump creating a new Task Force to Eliminate Fraud. The guidance contains several takeaways and raises practical questions for stakeholders involved with state-administered benefits programs.
Streamlined Review and Investigation
The new guidance instructs the government to “prioritize and, to the maximum extent practicable, complete its review” of new benefits fraud actions within the 60-day review period, and no later than 120 days. During this streamlined review period, DOJ will determine: (1) whether to permit the whistleblower to continue litigating the case; (2) whether the matter requires further investigation; or (3) whether the action should be dismissed under Section 3730(c)(2)(A). The new guidance contemplates this policy will result in more relator-led qui tams proceeding without DOJ intervention while preserving and prioritizing DOJ’s resources to investigate more complex, sophisticated fraud schemes.
The guidance also instructs that new FCA matters will be promptly referred to DOJ’s Criminal Division and/or the National Fraud Enforcement Division for evaluation of potential criminal violations.
Heightened Internal Approvals Needed to Extend Investigatory Review Period
If DOJ determines during the initial 60–120-day streamlined review period that a matter requires further investigation, it may extend review for an additional 120 days. During this time, the guidance directs DOJ to make appropriate and tailored requests for relevant information, utilizing subpoenas, Civil Investigative Demands (CIDs), and early witness interviews. The new guidance encourages DOJ to file actions to enforce CIDs if defendants fail to meet deadlines without justifiable reason. If, upon the completion of the initial investigative period, DOJ determines additional investigation is needed, government attorneys assigned to the matter must receive approval from the Deputy Assistant Attorney General of the Commercial Litigation Branch for an additional 120-day period. Any subsequent extension of the investigative period will require approval from the Assistant Attorney General of the Civil Division.
Use of Data Analytics
The new guidance underscores DOJ’s continued emphasis on the use of data analytics to ferret out fraud schemes. The new guidance directs the government to consider, during its investigatory review while the qui tam complaint is sealed, whether the complaint’s allegations are supported by data analytics. While the new guidance does not define data analytics in this context, DOJ’s April 2026 announcement of the FOCUS Initiative for Data Miners Filing Qui Tam Complaints suggests the government may leverage reliable data miners’ sophisticated AI platforms to detect otherwise undetectable fraud schemes. As AI tools become more refined and ubiquitous, companies may see an increase in relator-led qui tam cases brought by data miners rather than employee whistleblowers.
Does the Guidance Extend to State and Federal Hybrid Cases?
In the healthcare sector, some qui tam complaints allege the submission of false claims to both Medicaid (state administered) and Medicare or other federal healthcare programs (federally administered). The new guidance does not address whether the streamlined review applies to these hybrid cases — which are more common than cases involving fraud solely on a state-administered benefits program. If the new guidance does apply to these hybrid cases, it may result in faster unsealing of an even greater number of qui tam complaints alleging healthcare fraud.