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Criminal vs Civil Healthcare Fraud Enforcement: Insights from DOJ’s Latest Takedown

Brief

The podcast episode (hosted by Jonathan Porter) features Jody Rudman of Husch Blackwell in a presentation-format interview analyzing the intersection of criminal and civil healthcare fraud enforcement. Rudman explains why DOJ maintains dual tracks—civil FCA suits (lower burden, damages/treble) and criminal prosecutions (higher burden, intent)—and how the same scheme can trigger both. She reviews the June 2026 DOJ takedown, noting it was primarily criminal but generated significant FCA exposure and an unprecedented number of MFCU-initiated actions. The conversation highlights practical compliance lessons for providers, identifying kickbacks, patient brokering, medically unnecessary services, and intentional billing schemes as conduct most likely to prompt criminal referrals. Rudman concludes by examining DOJ’s FCA statistics and the conditions that could drive continued large-scale enforcement efforts in coming years.

Why it matters

Jody Rudman (Husch Blackwell) contrasts DOJ’s parallel enforcement: civil False Claims Act (FCA) cases proceed on a preponderance-of-the-evidence standard and target false claims and damages, while criminal healthcare fraud prosecutions require proof beyond a reasonable doubt and focus on intent.

Key details

  • The DOJ’s major healthcare fraud takedown in June 2026 was primarily criminal but carries substantial FCA exposure; the operation included an unprecedented number of Medicaid Fraud Control Unit (MFCU)-initiated actions, increasing civil follow-on risk for providers.
  • Specific conduct that often elevates enforcement from civil to criminal includes kickbacks, patient brokering, medically unnecessary services, and billing schemes that demonstrate clear intent to defraud, making these high-priority compliance red flags.
  • Rudman reviewed DOJ’s annual FCA statistics and warned that large-scale takedowns are likely to continue; future enforcement levels will hinge on factors such as MFCU activity, DOJ resourcing, and demonstrable evidence of intentional fraud.
Cleaned source text

Host Jonathan Porter (https://www.huschblackwell.com/professionals/jonathan-porter) welcomes back Jody Rudman (https://www.huschblackwell.com/professionals/jody-rudman) , who heads up Husch Blackwell’s white collar practice group, to the podcast to discuss the intersection of criminal and civil healthcare fraud enforcement. With the Department of Justice announcing another massive healthcare fraud takedown last month, Jody provides critical insights into how criminal prosecutions and False Claims Act enforcement work in tandem—and what healthcare providers need to understand about both.

We begin by examining why DOJ maintains two parallel enforcement mechanisms for healthcare fraud. Jody explains the fundamental differences between civil False Claims Act cases and criminal healthcare fraud prosecutions, including different burden of proof standards, the role of intent, and the types of conduct that trigger each pathway. We discuss how these two enforcement tools serve different purposes but often target the same underlying fraudulent schemes.

Next, we dive into last month’s major DOJ healthcare fraud takedown. While these enforcement actions are primarily criminal in nature, Jody explains the significant False Claims Act implications that follow. We explore the scope of the takedown, the types of schemes that are targeted, and how the takedown included more Medicaid Fraud Control Unit-initiated actions than ever before.

Our conversation then shifts to practical lessons for healthcare industry listeners. Jody identifies patterns and trends from recent enforcement activity that should serve as warning signs for providers. We discuss the types of conduct that elevate healthcare fraud from a civil matter to criminal prosecution, including the role of kickbacks, patient brokering, medically unnecessary services, and billing schemes that demonstrate clear intent to defraud.

We close by looking ahead to the future of healthcare fraud enforcement. Jody analyzes DOJ’s annual FCA statistics and the trajectory of these massive takedown operations. We examine whether enforcement numbers will continue climbing in coming years and what facts might influence the government’s enforcement strategy going forward.

Jonathan Porter | Full Biography (https://www.huschblackwell.com/professionals/jonathan-porter)

Jonathan focuses on white collar criminal defense, federal investigations brought under the False Claims Act, and litigation against the government and whistleblowers. He draws on his experience as a former federal prosecutor to guide clients in sensitive and enterprise-threatening litigation. At the Department of Justice, Jonathan earned a reputation as a top white-collar prosecutor and trial lawyer and was a key member of multiple international healthcare fraud takedowns and high-profile financial crime prosecution teams. He also teaches white collar crime as an adjunct professor of law at Mercer University School of Law.

Jody Rudman | Full Biography (https://www.huschblackwell.com/professionals/jody-rudman)

Jody serves as the Office Managing Partner for Husch Blackwell’s Austin office and leads the firm’s White Collar, Internal Investigations & Compliance practice group. She also heads up the firm’s False Claims Act working group. Jody has assisted clients across a wide range of industries with investigations, negotiations, mediations, pretrial matters, grand jury proceedings, civil lawsuits, criminal indictments, jury trials, sentencings, and appeals. She has tried dozens of jury and bench trials in the federal and state courts, argued before the U.S. Court of Appeals for the Fifth Circuit, and appeared before the U.S. Supreme Court. Prior to entering private practice, Jody served as a federal prosecutor for the Northern District of Texas and was appointed by the Texas Attorney General to spearhead high-profile charitable trust and healthcare litigation matters for the State of Texas.

Channel: Husch Blackwell

Published: 2026-07-22

Video URL: https://www.youtube.com/watch?v=-wZzxrYMhXY