DOJ FOCUS Initiative Prioritizes “High Quality” Data Miner Actions by FCA Whistleblowers

On April 30, 2026, the Department of Justice (DOJ) announced plans to prioritize “high quality” actions by data miners filing False Claims Act (FCA) qui tam complaints, indicating an ever-growing reliance on FCA whistleblowers as well as technology to uncover fraud, waste, and abuse.

The new program, called the Fraud Oversight Through Careful Use of Statistics (FOCUS) Initiative, will “improve the Department’s ability to prioritize working with the most successful data miners,” the DOJ claims.

Deputy Assistant Attorney General Brenna E. Jenny said in the press release that the DOJ was “interested in hearing from data miners who believe they have developed particularly effective tools for detecting fraud against the government.” To that end, the DOJ is inviting these data miners to meet with the Civil Fraud Section to “explain what differentiates their approach, how they validate their findings, and why their methodology provides a reliable basis for identifying high-quality, actionable [FCA] matters,” Jenny stated.

Data Miners as FCA Whistleblowers

The civil FCA (31 U.S.C. §§ 3729-3733 et seq.), originally enacted in 1863 to prevent defense contractor fraud during the American Civil War, is unique in that it allows qui tam relators—private whistleblowers acting on the government’s behalf—to sue an entity that knowingly submits false claims for payment to the federal government.

The FCA provides that any person who knowingly submits, or causes to submit, false claims to the government is liable for three times the government’s damages plus a penalty that is linked to inflation. Persons found liable for violating the FCA can be on the hook for millions of dollars, giving whistleblowers a strong incentive to come forward (and take a piece of the pie). If the government proceeds with an action brought by a qui tam relator, the relator is entitled to receive between 15 and 25 percent of the government’s recovery; if the relator proceeds alone, that relator is entitled to receive between 25 and 30 percent.

As the DOJ announcement notes, qui tam relators have traditionally been individuals with inside knowledge, such as an employee who discovers that the company is submitting false claims to Medicare and Medicaid. Some relators, however—driven by the prospect of big recoveries—have been unconnected entities who analyze publicly available government data for potential signs of fraud (data miners).

U.S. ex rel. Integra Med Analytics v. Baylor Scott & White Health

The DOJ’s call for effective data miners will not relieve the latter of their obligation, in an FCA complaint, to meet the heightened pleading standard of Federal Rule of Civil Procedure (FRCP) 9(b)—which provides that “[i]n alleging fraud or mistake, a party must state with particularity the circumstances constituting fraud or mistake.”

In 2020, the U.S. Court of Appeals for the Fifth Circuit affirmed a district court decision to dismiss, for failure to state a claim, an FCA complaint alleging that a health system and its affiliates used inflated codes to bill Medicare. The Fifth Circuit held in U.S. ex rel. Integra Med Analytics v. Baylor Scott & White Health, 816 F. App’x. 892 (5th Cir. 2020), that the relator, who was unconnected to the defendant health system, failed to plead a false statement or fraudulent course of conduct with particularity based on statistical data.

Integra Med had analyzed inpatient claims data from the Centers for Medicare & Medicaid Services (CMS), concluding that Baylor Health had claimed major complications or comorbidities in its diagnosis codes at a rate significantly higher than the national average. While the Fifth Circuit noted that statistical data can be used to meet the pleading requirements of FRCP 8(a) and the particularity requirements of FRCP 9(b), Integra Med failed to meet both; the statistical data was not sufficient to show that the Medicare reimbursement claims were false. In this case, one “obvious alternative explanation” for the statistical data, besides Baylor submitting false Medicare reimbursement claims, was that it was actually ahead of the health care industry in following certain CMS guidelines.

“The claims of falsity are simply conclusory,” the court wrote.   

Enforcement Trends

Despite constitutional challenges to the FCA’s qui tam provisions—the Eleventh Circuit heard oral arguments in December (see related posts here and here), and the Third Circuit did so in March—whistleblowers are on the rise. The DOJ reports that it received a record 980 FCA qui tam complaints in fiscal year (FY) 2024 and nearly 1,300 in FY 2025 (see related post here, regarding the rise of whistleblower-led litigation in health care). The DOJ has received more than 780 qui tam complaints so far in FY 2026.

The DOJ’s April 30 announcement attributes the rise in whistleblowers to data miners as opposed to traditional whistleblowers. Since FY 2024, data miners have filed more than 45 percent of all qui tam complaints.

The agency seems eager for the help. The July 2025 announcement of a revamped FCA Working Group encouraged whistleblower reports in high-priority enforcement areas (see related post here). A June 11, 2025, DOJ memorandum promised an aggressive investigation and use of the FCA against “entities that receive federal funds but knowingly violate civil rights laws” and submit claims for “impermissible” gender-affirming care (see related post here).

Further, the DOJ’s Civil Rights Fraud Initiative—announced in May 2025—will leverage the FCA to investigate and litigate against entities that accept federal funds but allegedly violate civil rights laws. That announcement strongly encouraged whistleblowers to come forward and report “instances of such discrimination” (see related post here).  

Takeaways

Encouraging data miners to try to meet the standards of qui tam relators is now one more part of the DOJ’s strategy promising an aggressive use of the FCA. As with traditional whistleblowers, businesses need to be especially careful with respect to FCA compliance in priority areas such as health care and employment, particularly relating to diversity, equity, and inclusion initiatives.

Businesses and their counsel should note that the DOJ—apparently taking note of the Integra Med case—offers the following guidance to data miners/relators and their counsel for a successful FCA suit on their side:

• The most successful relators identify a clear and material violation of a statutory, regulatory, or contractual obligation and provide the government with a cogent investigative roadmap of facts to corroborate, witnesses to interview, and evidence to obtain.
• Data miners should be mindful of the heightened pleading standard of FRCP 9(b) that applies to complaints alleging fraud. That standard includes the obligation to state with particularity the circumstances constituting fraud.
• When considering whether to file a qui tam complaint, the best data miners will assess potential alternative explanations for the observed conduct and be able to articulate how the data, in combination with other available evidence, suggests both scienter and falsity.
• Data miners should also take steps to adequately understand program eligibility requirements and relevant regulatory frameworks and articulate them in their complaints.

If you have questions regarding the issues discussed in this post, please reach out to the authors.

Epstein Becker Green Staff Attorney Ann W. Parks contributed to the preparation of this post.