Editor’s note: Ashley Joyner Chavous is a congressional investigations and white collar defense attorney at law firm Holland & Knight’s Washington, D.C., office. Christopher Armstrong is a Washington, D.C., attorney and a member of the law firm’s public policy & regulation group.
With congressional Democrats eyeing potential majorities in the 120th Congress, future investigations are already a top priority. In addition to oversight of the Trump administration, much of the focus will be on consumer-facing issues with an emphasis on affordability. Although healthcare has historically been a bipartisan oversight target, a potential shift in congressional control would likely expand investigations beyond longstanding concerns such as affordability, consolidation and fraud to include inquiries tied directly to the Trump administration, federal contracting, regulatory decision-making and relationships between industry and political appointees.
Even though the 2026 midterm elections remain months away, many congressional staff members have already begun preparing investigative frameworks, requesting that companies preserve information and cultivating external sources. Companies that wait until after the election to assess exposure may find themselves responding to congressional inquiries under compressed timelines and heightened public scrutiny.
Importantly, congressional investigators are expected to focus heavily on private sector entities rather than relying exclusively on executive branch oversight. Companies, trade associations, consultants, investors and contractors that interact with federal healthcare programs or Trump administration officials may therefore face heightened legal, reputational and political risk.
Key areas of congressional oversight
Affordability and healthcare costs
Affordability is likely to remain the dominant organizing principle for congressional healthcare oversight over the next several years. Persistent concerns over healthcare inflation, prescription drug costs, insurance premiums and out-of-pocket expenses continue to resonate politically across party lines. These investigations are likely to include matters such as drug pricing strategies and manufacturer price increases, insurance premium increases and cost-sharing structures, facility fees and billing practices, compliance with the No Surprises Act, and medical debt collection and credit reporting practices.
Private equity and the financialization of healthcare
Congressional Democrats are expected to continue expanding scrutiny of private equity ownership in healthcare. Building on prior investigations involving nursing homes, emergency physician staffing groups and specialty practices, future inquiries may focus on whether financial ownership structures negatively affect patient care, staffing levels, service availability and long-term system stability. Expected focuses of these inquiries include hospital acquisitions and closures, nursing home ownership structures, real estate investment structures involving healthcare facilities, and staffing reductions following acquisitions.
Hospital consolidation and market power
Hospital systems and vertically integrated healthcare organizations are expected to remain major oversight targets. Committees with jurisdiction over Medicare, Medicaid, antitrust and consumer protection issues may examine whether consolidation has contributed to rising prices, declining competition or reductions in care quality. In addition to related inquiries on affordability, these inquiries may explore acquisition of physician groups by health systems, facility closures and service line reductions, labor impacts and staffing shortages, and use of nonprofit status and community benefit obligations. This congressional scrutiny may increasingly overlap with investigations by the Federal Trade Commission, Department of Justice, state attorneys general and private antitrust litigation.
Artificial intelligence, algorithms and healthcare data
Congressional concern regarding artificial intelligence in healthcare has accelerated substantially over the past year. Committees are increasingly focused not only on AI innovation but also on transparency, accountability, bias and data-sharing practices. Recent and planned congressional oversight efforts are focusing on AI-assisted prior authorization systems, bias affecting vulnerable populations, the sharing of patient data with technology companies, and cybersecurity and data protection practices. Congressional oversight may expand beyond healthcare companies themselves to include cloud providers, data analytics firms and major technology companies involved in healthcare infrastructure.
Oversight risks tied to the Trump administration
If Democrats regain congressional control, healthcare-related investigations tied to the Trump administration are likely to expand significantly, with the added power to issue subpoenas increasing risk to private-sector organizations with close ties to the Administration.
Perceived conflicts of interest and ethics concerns
Democratic lawmakers have repeatedly expressed concern regarding potential conflicts of interest involving political appointees, special government employees and individuals with financial ties to regulated industries. While responses from federal agencies may remain limited, private sector focuses may include communications between industry executives and administration officials, ethics waivers and recusal compliance, relationships involving consultants and advisors, investments held by current or former officials, and alleged preferential treatment in regulatory or contracting decisions. Healthcare entities with close relationships to political leadership or administration-linked advisors may face requests for records, communications and meeting documentation.
Negotiations with federal agencies
Congressional Democrats are also expected to examine negotiations between healthcare companies and the Trump administration involving pricing arrangements, regulatory settlements, enforcement discretion and procurement matters. Likely subjects of inquiry include drug pricing negotiations and most favored nation-related initiatives, DOJ settlements and enforcement discussions, regulatory approvals perceived as politically influenced, contracting decisions involving HHS or CMS, communications regarding Medicare pricing models, and interactions involving pharmaceutical tariff or trade policies. Particular attention may focus on initiatives such as the Global Benchmark for Efficient Drug Pricing and Guarding U.S. Medicare Against Rising Drug Costs models, especially where private negotiations, pricing concessions or regulatory outcomes lack transparency.
Federal contracts and healthcare funding
Congressional investigators may also examine healthcare-related federal contracts awarded during the Trump administration, particularly where contracts involve politically connected vendors, emerging technologies or emergency procurement. Committees may seek records related to procurement processes, lobbying efforts, communications with political officials and contractor performance, with particular focus on matters such as CMS technology modernization contracts, consulting agreements, AI and data analytics vendors, and Medicare and Medicaid contractor relationships.
Preparing for a new era of congressional scrutiny
Healthcare organizations should act now, including by:
- Reviewing document retention and communications policies
- Conducting risk assessments related to congressional oversight exposure
- Evaluating interactions with federal officials and agencies
- Assessing cybersecurity and data governance practices
- Reviewing pricing, billing and utilization management procedures
- Preparing coordinated legal, policy and communications response plans
- Training executives and employees on congressional investigation protocols
Congressional investigations are unlike traditional litigation or regulatory enforcement. They unfold publicly, and the legal, political, reputational and media risks arrive at once. Regardless of which party controls Congress after November, healthcare companies should expect sustained bipartisan scrutiny driven by affordability concerns, federal spending pressures and deep public distrust of healthcare pricing and consolidation. The window before the next Congress convenes is the best opportunity to assess exposure and get ahead of it.
