DOJ Charges 324 in Sprawling $14.6 Billion Health Care Fraud Scams
Federal law enforcement agencies this week unveiled expansive and long-running investigations into multiple health care fraud operations that ranged from wound care and opioids to telemedicine and genetic testing, involved transnational criminal organizations and U.S. medical professionals, and racked up $14.6 billion in losses to Medicare and Medicaid.
In all, the Justice Department (DOJ) filed charges against 324 people, including 96 licensed medical professions – such as doctors, nurses, and pharmacists – and 29 people in Estonia and Pakistan.
The complex fraudulent schemes included foreign operators that investigators said were part of transnational criminal organizations and are accused of buying medical supply companies through which they filed false claims, substance abuse treatment center owners allegedly conspiring with a Pakistani man to bill Medicaid for services that were either substandard or non-existent, and executives with marketing companies in Pakistan allegedly using AI deepfake technology to create fake recordings of Medicare patients seeming to agree to receiving certain health care products and then filing false claims.
The various law enforcement operations were part of what the DOJ is calling its 2025 National Health Care Fraud Takedown.
“The scale of today’s Takedown is unprecedented, and so is the harm we’re confronting,” Juliet Hodgkins, acting inspector general of the Department of Health and Human Services, said in a statement.
A Wide-Ranging Problem
The cases outlined by the DOJ illustrate the scale of health care fraud. The National Health Care Anti-Fraud Association says the United States spends more than $2.27 trillion on health care every year and puts the annual health care fraud figure at tens of billions of dollars.
One investigation, called Operation Gold Rush – the largest health care fraud case in U.S. history – resulted in the arrest of 12 people, including four from Estonia and seven others who were arrested at U.S. airports and the Mexican border trying to escape. The case involved people sent to the United States who, using false identities and communicating to others overseas via encrypted messaging services, bought dozens of medical supply companies in the Untied States and then submitted $10.6 billion in fraudulent claims to Medicare for urinary catheters and other durable medical equipment.
As part of the operation, the suspects allegedly used stolen identities and medical information of more than 1 million U.S. to submit the false claims and then laundered the money through the U.S. financial systems to transfer the funds into cryptocurrency and shell companies abroad. Among those arrested was a banker who is accused of helping to launder the money through a U.S. bank.
About $900 million was paid out through the scam, but investigators said they seized about $27.7 million.
Stolen Data, Deepfakes, and Fraud
In another $703 million scheme, two Pakistani individuals who are executives with marketing companies in that country are accused of using identification numbers and other confidential health data stolen through theft and deceptive marketing to create AI-based fake recordings of Medicare patients agreeing to buying products. The confidential information was then sold to laboratories and medical equipment companies that used it to submit false claims to Medicare.
Some defendants controlled dozens of the companies and labs and conspired to launder the proceeds through U.S. bank accounts to overseas accounts.
Seven people, including five medical professionals, were accused in a $1.1 billion operation of filing false claims to Medicare and other health care programs for wound care that were applied improperly, unnecessary, and outside of the patients’ physicians’ care. They allegedly targeted elderly patients, including some who were hospice care. Some defendants are accused of getting millions of dollars in illegal kickbacks.
There also was a prescription drug operation that involved 74 defendants – including 44 medical professionals – and the diversion of more than 15 million prescription opioids and other controlled substances. In one case, five suspects associated with a Texas pharmacy allegedly distributed more than 3 million opioid pills – such as oxycodone, hydrocodone, and carisoprodol – that found their way to street-level dealers.
In addition, the Drug Enforcement Administration said that over the past six months, it filed 93 requests to revoke the authority to handle or prescribe controlled substances of pharmacies, medical practitioners, and companies.
Fake Telemedicine and Genetic Testing
In addition, another 49 people were charged with submitting more than $1.17 billion in fraudulent Medicare claims connected to fake telemedicine and genetic testing. In one $46 million case, the owner for a telemedicine and medical equipment company for targeting Medicare patients with deceptive telemarketing and then filing false claims for medical equipment and genetic tests.
Another aspect of the DOJ’s broad investigations included charging 170 people in other schemes involving more than $1.84 billion in fraudulent claims to Medicare, Medicaid, and private health insurance companies for such services as diagnostic tests, medical visits, and treatments that were medically unnecessary and involved kickbacks and bribes, or were never provided.
