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WASHINGTON, D.C. — In a record-breaking enforcement action, the U.S. Department of Justice announced Friday it’s charging 324 defendants across 50 federal districts and 12 state attorneys general offices in healthcare fraud schemes totaling more than $14.6 billion in intended losses.
The results of the DOJ investigation saw the healthcare fraud totaling more than $14.6 billion in intended losses, according to a press release.
The sweeping operation, which involved the coordinated efforts of federal and state law enforcement agencies, led to criminal charges against 96 licensed medical professionals, including doctors, nurses, and pharmacists.
Authorities also seized over $245 million in cash, cryptocurrency, luxury vehicles, and other assets.
“This record-setting Health Care Fraud Takedown delivers justice to criminal actors who prey upon our most vulnerable citizens and steal from hardworking American taxpayers,” said Attorney General Pamela Bondi.
“Make no mistake – this administration will not tolerate criminals who line their pockets with taxpayer dollars while endangering the health and safety of our communities.”
As part of the crackdown, the Centers for Medicare and Medicaid Services (CMS) announced that it prevented more than $4 billion in fraudulent payments and suspended or revoked the billing privileges of 205 providers.
Civil charges were also filed against 20 defendants, while 106 civil settlements totaling $34.3 million were reached.
Secretary Robert F. Kennedy Jr. of Health and Human Services emphasized the broader implications:
“As part of making healthcare accessible and affordable to all Americans, HHS will aggressively work with our law enforcement partners to eliminate the pervasive healthcare fraud that bedeviled this agency under the former administration and drove up costs.”
The Justice Department said transnational criminal organizations played a major role, with 29 defendants accused of submitting over $12 billion in fraudulent claims. One operation, dubbed “Operation Gold Rush,” resulted in 19 defendants charged across five federal districts.
Defendants allegedly used stolen identities of more than one million Americans to submit $10.6 billion in fake Medicare claims, primarily for urinary catheters and durable medical equipment.
Authorities are charging 19 suspects, with 12 arrested, including four in Estonia and seven at U.S. airports and borders. Roughly $27.7 million has been seized from this operation so far.
CMS and HHS managed to prevent more than $4.4 billion in scheduled payments from being released.
In another case based in Illinois, defendants allegedly used AI-generated voice recordings to impersonate Medicare beneficiaries, submitting $703 million in false claims, of which $418 million was paid. $44.7 million was seized in connection with that case.
An additional scheme involved a defendant in Pakistan and the UAE who conspired with U.S.-based addiction treatment centers to fraudulently bill $650 million to Arizona Medicaid.
Services were either not provided or were substandard, with patients recruited from homeless populations and Native American reservations.
Fraudulent wound care also played a significant role, with $1.1 billion in alleged fraud involving amniotic allografts targeting hospice patients.
Some providers applied unnecessary grafts without proper coordination or infection treatment.
“Today’s unprecedented enforcement action demonstrates that CMS and our federal partners are united in our mission to protect the integrity of Medicare and Medicaid,” said CMS Administrator Dr. Mehmet Oz.
Prescription opioid fraud accounted for 15 million pills illegally distributed by 74 defendants across 58 cases.
A Texas pharmacy allegedly distributed over 3 million pills. Acting DEA Administrator Robert Murphy stated, “If you abuse your medical license to push poison or pad your pockets, we will hold you accountable.”
The Takedown also uncovered $1.17 billion in fraud through telemedicine and genetic testing scams, including a $46 million scheme in Florida.
In total, 170 more defendants were charged in unrelated schemes for an additional $1.84 billion in fraudulent claims.
“The scale of today’s Takedown is unprecedented, and so is the harm we’re confronting,” said Juliet T. Hodgkins, Acting Inspector General of HHS-OIG. “Our agents work relentlessly to dismantle these fraud schemes.”
FBI Director Kash Patel added, “With more than $13 billion in fraud uncovered, this is the largest takedown for this initiative to date. Together, the FBI and our law enforcement partners will continue to hold those accountable who steal from the American people.”
To further combat health care fraud, the DOJ announced a new Health Care Fraud Data Fusion Center to integrate advanced data analytics, AI, and interagency collaboration, in alignment with President Biden’s Executive Order 14243.
This year’s enforcement action was coordinated by the DOJ’s Criminal Division, HHS-OIG, the FBI, DEA, CMS, and numerous U.S. Attorneys’ and State Attorneys General’s Offices.
It builds on the Health Care Fraud Strike Force’s legacy, which has charged more than 5,400 defendants responsible for over $27 billion in fraud since 2007.
An indictment is an allegation, and all defendants are presumed innocent until proven guilty in a court of law.
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