Control of Congress has changed. The bipartisan appetite for scrutinizing practices across the healthcare industry has not. A new Democratic majority will arrive with no shortage of investigative priorities and only so much time to pursue them, but recent history suggests that healthcare is likely to be among them.
Affordability dominated this election cycle, and healthcare sits at the center of that debate. Combating fraud in Medicare and Medicaid has endured as a rare point of consensus precisely because it allows policymakers of both parties to say they are protecting patients and taxpayers at once. The open question is not whether that work continues, but where it is directed.
Congressional oversight largely reflects the priorities of the majority, which controls committee agendas, hearings and subpoenas. If recent history is a guide, a Democratic majority will gravitate toward a familiar set of concerns: the practices of large insurers including those involved in Medicare Advantage, the stewardship of hospital systems, the role of private equity, vertical integration across the industry, drug pricing, and the hyper-growth sectors attracting new investment.
Enforcement at scale
The administration has elevated healthcare fraud to the top of its enforcement agenda. The Justice Department’s 2026 National Health Care Fraud Takedown charged 455 defendants in schemes involving more than $6.5 billion in alleged losses, with particular emphasis on Medicaid, while CMS suspended or revoked the billing privileges of more than 2,400 providers. In an October 1 directive, DOJ’s newly created National Fraud Enforcement Division went further, designating healthcare fraud its foremost corporate enforcement priority.
That model has been defined largely by scale: the number of defendants charged and the dollar value of alleged fraud identified. It will persist regardless of which party holds Congress, carried forward by entrepreneurial prosecutors and agents. What a Democratic majority could add is a complementary lens, one that weighs not only how much fraud is charged but how the industry’s largest and fastest-growing participants are organized, owned and paid.
What past oversight suggests
The best predictor of the next two years may be the last several. While Democrats controlled the Senate Permanent Subcommittee on Investigations, its October 2024 majority staff report examined post-acute care denials by the largest Medicare Advantage insurers. That inquiry did not end with the change in Senate control. In July 2026, Sen. Richard Blumenthal (D-Connecticut) and Sen. Josh Hawley (R-Missouri) sought updated data from one of those insurers on its prior authorization practices and its use of algorithms in coverage decisions. In the House, Democrats have called for closer scrutiny of insurer practices at nursing homes serving Medicare Advantage members.
Hospitals have drawn bipartisan attention as well. A January 2025 Senate Budget Committee report on private equity ownership of hospitals, led by Sen. Sheldon Whitehouse (D-Rhode Island) and Sen. Chuck Grassley (R-Iowa), raised concerns about staffing, hospital closures and distributions to investors. Months earlier, the Senate HELP Committee, then chaired by Sen. Bernie Sanders (I-Vermont), subpoenaed the chief executive of a bankrupt, private equity-backed hospital system, and the full Senate voted unanimously to hold him in contempt after he declined to testify.
Concern extends to the structure of the industry itself. In May 2026, Sen. Elizabeth Warren (D-Massachusetts) and Sen. Josh Hawley, joined by House members from both parties, reintroduced legislation that would require companies that own pharmacy benefit managers to divest their pharmacies, a measure that would force significant restructuring at some of the largest vertically integrated healthcare companies. Drug pricing has drawn similar scrutiny. In September 2024, the HELP Committee called the chief executive of a leading manufacturer of GLP-1 drugs to testify about U.S. prices for its diabetes and weight-loss treatments.
To the extent healthcare commands the new majority’s attention, the tools at its disposal are considerable. Committee chairs can compel documents and testimony by subpoena, require executives to testify under oath and publish staff reports that place internal records in the public domain.
Committees’ influence extends well beyond the hearing room. They can call on the Government Accountability Office and the HHS Office of Inspector General to examine particular programs, press CMS for data and refer matters to the Justice Department. Through legislation and appropriations, they can push for reforms in areas such as prior authorization, Medicare Advantage payment and transparency in private equity ownership. Oversight does not generate cases on its own, but it shapes where agencies look, which documents surface, and what insiders conclude is worth reporting. It shapes public opinion as well. Under the glare of hearings and headlines, a misstep that might once have been resolved quietly can escalate into a reputational and regulatory crisis.
Fast-growing healthcare sectors
Scrutiny of private equity tends to follow the sectors where investment has moved fastest. Applied behavior analysis (ABA) therapy for children with autism illustrates the dynamic. The underlying demand is genuine: the CDC estimates that one in 31 children has autism spectrum disorder. Private equity firms have acquired more than 500 autism therapy centers over the past decade, and CMS reported in August that Medicaid and CHIP spending on ABA rose 421% between 2021 and 2025, far outpacing the 67% growth in the number of children served.
Whatever the causes of that gap, regulators have begun to respond. CMS issued a toolkit to help states strengthen oversight of ABA services, New York halved Medicaid reimbursement for certain ABA services in October, citing program integrity concerns, and Indiana paused new ABA provider enrollment. Sectors that combine rapid growth, substantial public funding and concentrated investor ownership are natural subjects of congressional interest, whichever party is in the majority.
What to watch
Should the emphasis shift, Medicare Advantage is the likeliest starting point, given the sustained attention already paid to prior authorization, post-acute care denials, algorithm-driven coverage decisions and risk adjustment. Beyond it, the record points to three broader fronts that track how the industry is organized, owned, and paid. The first is integration, as lawmakers ask whether combining insurers, pharmacy benefit managers, pharmacies and providers under one corporate roof serves patients. The second is ownership, as committees examine how private equity affects staffing, billing and quality at hospitals and in hyper-growth sectors in healthcare. The third is pricing, particularly for prescription drugs.
For companies in these areas, the practical consequence is that exposure can arrive before any agency acts, and congressional and Justice Department scrutiny tend to reinforce each other. A single congressional letter can place internal records and decision-making in public view, and the attention that follows tends to encourage potential whistleblowers to come forward. Those insiders have strong incentives to take their concerns to the Justice Department as well. Under the False Claims Act, a whistleblower who files a qui tam suit may receive between 15% and 30% of the government’s recovery, and DOJ’s Corporate Whistleblower Awards Pilot Program offers awards for original information about criminal healthcare fraud, including fraud against private insurers.
The overlap in subject matter is considerable. The joint DOJ-HHS False Claims Act Working Group has named Medicare Advantage and drug pricing among its enforcement priorities, the same areas that have drawn sustained congressional interest. Testimony and documents made public through oversight can become a road map for relators’ counsel and prosecutors alike, and many healthcare fraud cases still originate with an insider.
For companies and investors, the prudent response does not depend on who holds the gavel. It begins with a clear-eyed understanding of where the business’s risks reside, followed by rigorous testing of controls in the areas of fastest growth and highest reimbursement, and a willingness to address problems early, with the benefit of counsel where the facts are uncertain. Enforcement priorities shift with each election. The expectation that companies will identify and remedy their own problems does not.
Kevin Lowell is a member at Miller & Chevalier and previously served as deputy chief of the National Fraud Enforcement Division at the U.S. Department of Justice.