(The Center Square) – Justice Department leaders announced a $14.6 billion health care fraud bust on Monday involved 324 people, including 96 licensed medical professionals involved in everything from pill mills to ripping off government medical programs.
DOJ officials announced the results of its 2025 National Health Care Fraud Takedown, which involved federal and state law enforcement agencies across the country. The federal government seized more than $245 million in cash, luxury vehicles, cryptocurrency, and other assets as part of the effort.
Department of Justice announces “largest coordinated healthcare fraud takedown in the history of the Department of Justice”
The Centers for Medicare and Medicaid Services said it prevented more than $4 billion from being paid in response to false and fraudulent claims. It also suspended or revoked the billing privileges of 205 providers in the months leading up to the bust. The bust also resulted in civil charges against 20 defendants for $14.2 million in alleged fraud, and civil settlements with 106 defendants totaling $34.3 million.
Matthew Galeotti, head of the Justice Department’s Criminal Division, said Monday that the fraudsters were stealing from American taxpayers.
“These schemes: (1) often result in physical patient harm through medically unnecessary treatments or failure to provide the correct treatments; (2) contribute to our nationwide opioid epidemic and exacerbate controlled substance addiction; and (3) do all of that while stealing money hardworking Americans contribute to pay for the care of their elders and other vulnerable citizens,” he said at a news conference Monday.
Some of the schemes involved transnational criminal organizations. Twenty-nine defendants were charged for their roles in transnational criminal organizations alleged to have submitted more than $12 billion in fraudulent claims to U.S. health insurance programs. One group bought dozens of medical supply companies located across the U.S. as part of the fraud scheme.
In one case, a nationwide investigation known as Operation Gold Rush, federal officials charged 19 defendants. Twelve were arrested, including four who were picked up in Estonia and seven defendants who were arrested in the U.S. Prosecutors said the organization used a network of foreign straw owners, including people sent to the United States from abroad, who bought medical supply companies and then rapidly submitted $10.6 billion in fraudulent health care claims to Medicare for urinary catheters and other durable medical equipment by exploiting the stolen identities of more one million Americans spanning all 50 states and using their confidential medical information to submit the fraudulent claims.
The arrests announced Monday also include a banker who facilitated the money laundering of fraud proceeds on behalf of the organization through a U.S.-based bank, prosecutors said.
The Health Care Fraud Unit’s Data Analytics Team detected the anomalous billing and prevented the organization from receiving all but approximately $41 million of roughly $4.45 billion that was scheduled to be paid by Medicare. HHS and CMS intend to seek to return the $4.41 billion in escrow to the Medicare trust fund for needed medical care. The scheme nonetheless resulted in payments of approximately $900 million from Medicare supplemental insurers. Law enforcement has seized about $27.7 million in fraud proceeds as part of Operation Gold Rush.
In the Northern District of Illinois, prosecutors filed charges against five defendants, including two owners and executives of Pakistani marketing organizations, in connection with a $703 million scheme in which Medicare beneficiaries’ identification numbers and other confidential health information were allegedly obtained through theft and deceptive marketing. The defendants allegedly used artificial intelligence to create fake recordings of Medicare beneficiaries consenting to receive certain products. The confidential information was then illegally sold to laboratories and durable medical equipment companies, which used it to submit false claims to Medicare. Some defendants controlled dozens of nominee-owned durable medical equipment companies and laboratories that allegedly submitted fraudulent claims for products and services the beneficiaries did not request, need, or receive. Some defendants also allegedly conspired to conceal and launder the fraud proceeds from bank accounts they controlled in the United States to bank accounts overseas. The defendants caused approximately $703 million in alleged fraudulent claims to Medicare and Medicare Advantage plans, which paid about $418 million on those claims. The government seized about $44.7 million from various bank accounts related to this case.
Another defendant based in Pakistan and the United Arab Emirates who owned a billing company allegedly orchestrated a scheme to prey upon vulnerable individuals in need of addiction treatment by conspiring with treatment center owners to fraudulently bill Arizona Medicaid about $650 million for substance abuse treatment services. Some of the services billed were never provided, while other services were provided at a level that was so substandard that it failed to serve any treatment purpose, according to court records. As part of the conspiracy, treatment center owners allegedly paid illegal kickbacks in exchange for the referral of patients recruited from the homeless population and Native American reservations. The defendant acquired at least $25 million in Arizona Medicaid funds due to the conspiracy. He was also charged with a money laundering offense for allegedly use of those funds to buy a $2.9 million home on a golf estate in Dubai.
Fraudulent wound care
Prosecutors filed charges in the District of Arizona and the District of Nevada against seven defendants, including five medical professionals, concerning $1.1 billion in fraudulent claims to Medicare and other healthcare benefit programs for amniotic wound allografts. Some defendants targeted vulnerable elderly patients, many of whom were receiving hospice care, and applied medically unnecessary amniotic allografts to their wounds. Many of the allografts allegedly were applied without coordination with the patients’ treating physicians, without proper treatment for infection, to superficial wounds that did not need this treatment, and to areas that far exceeded the size of the wound. Some defendants allegedly received millions in illegal kickbacks from the fraudulent billing scheme, prosecutors said.
“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 by crushing waste, fraud, and abuse,” CMS Administrator Dr. Mehmet Oz said. “Every dollar we prevent from going to fraudsters is a dollar that stays in the system to serve legitimate beneficiaries.”
Prescription opioid trafficking
Seventy-four defendants, including 44 licensed medical professionals, were charged across 58 cases in connection with the alleged illegal diversion of over 15 million pills of prescription opioids and other controlled substances.
For instance, five defendants associated with one Texas pharmacy were charged with the unlawful distribution of over 3 million opioid pills. The defendants conspired to distribute massive quantities of oxycodone, hydrocodone, and carisoprodol, a highly addictive muscle relaxant.
Prosecutors said street-level drug dealers sold the pills, generating profits for the defendants.
DEA also announced Monday that in the last six months, DEA charged 93 administrative cases seeking the revocation of pharmacies, medical practitioners, and companies authority to handle and/or prescribe controlled substances.
Telemedicine and genetic testing fraud
Another 49 defendants were charged in connection with the submission of over $1.17 billion in allegedly fraudulent claims to Medicare resulting from telemedicine and genetic testing fraud schemes.
For example, in the Southern District of Florida, prosecutors charged an owner of telemedicine and durable medical equipment companies with a $46 million scheme in which Medicare beneficiaries were allegedly targeted through deceptive telemarketing campaigns and then fraudulent claims were submitted to Medicare for durable medical equipment and genetic tests for these beneficiaries.
