by The Justice Department has announced one of the largest health care fraud takedowns in U.S. history, charging 324 individuals, including 96 licensed medical professionals, in a sprawling scheme totaling $14.6 billion in alleged fraud.
Why It Matters
- Fraud targeted Medicare, Medicaid, and private insurers, harming taxpayers and vulnerable patients.
- DOJ and federal partners seized over $245 million in assets, including cash, luxury vehicles, and cryptocurrency.
- The operation involved pill mills, false claims, fake identities, and opioid trafficking.
- CMS prevented $4 billion in fraudulent payments and suspended 205 providers.
Major Operations and Schemes
Operation Gold Rush
- 19 defendants charged, 12 arrested (including 4 in Estonia)
- Used stolen identities of over 1 million Americans
- Submitted $10.6 billion in fake Medicare claims for catheters and medical equipment
- Medicare paid out $900 million, but most was blocked or recovered
- $27.7 million seized in fraud proceeds
$703 Million AI-Driven Fraud in Illinois
- Five defendants charged, including two from Pakistani marketing firms
- Used AI-generated recordings to forge patient consent
- Sold confidential Medicare data to labs and equipment companies
- Medicare paid $418 million, $44.7 million seized from U.S. and overseas accounts
Arizona Medicaid Scam
- Defendant based in Pakistan and UAE coordinated $650 million in fake addiction treatment billing
- Services were either never delivered or dangerously substandard
- Recruited patients from homeless communities and Native reservations
- Acquired $25 million, purchased a $2.9 million home in Dubai
$1.1 Billion Wound Care Scam
- Seven charged, including five medical professionals
- Billed for unnecessary amniotic wound allografts
- Targeted elderly hospice patients, bypassing primary care physicians
- Some defendants received millions in kickbacks
Prescription Opioid Distribution
- 74 charged, including 44 medical professionals
- Involved in the illegal distribution of 15 million opioid pills
- Example: Texas pharmacy linked to over 3 million pills of oxycodone, hydrocodone, and carisoprodol
- DEA launched 93 administrative revocations of licenses
Telemedicine and Genetic Testing Fraud
- 49 defendants charged in schemes totaling $1.17 billion
- Example: Florida man operated telemedicine and DME businesses, billing $46 million using deceptive telemarketing to exploit seniors
What Happens Next
- DOJ and CMS will continue enforcement, seize remaining funds, and restore recovered money to Medicare
- Additional disciplinary actions and civil charges expected in coming months
- Authorities say ongoing data analytics will detect future anomalies
The bust serves as a stern warning to fraudsters exploiting the healthcare system—and a win for taxpayers, patients, and law enforcement.
