The Department of Justice announced the results of its annual healthcare fraud “takedown” this week, in which they charged 324 defendants with $14.6 billion of medical fraud.
Defendants include 96 licensed medical professionals “in 50 federal districts and 12 State Attorneys General’s Offices across the United States.”
“With more than $13 billion in fraud uncovered, this is the largest takedown for this initiative to date,” said FBI director Kash Patel. The initiative identified $2.75 billion in fraud in 2024 and $2.5 billion in 2023.
“The government seized over $245 million in cash, luxury vehicles, cryptocurrency, and other assets,” the Justice Department stated.
In addition, the Centers for Medicare and Medicaid Services “prevented over $4 billion from being paid in response to false and fraudulent claims and that it suspended or revoked the billing privileges of 205 providers in the months leading up to the Takedown.” Civil charges and settlements amount to another $48.5 million.
The busted fraud schemes involve identity theft, fraudulent wound care, prescription opioid trafficking, and fake telemedicine claims.
One transnational criminal organization alone was responsible for $10.6 billion of the $14.6 billion in total fraud identified.
A network of foreign individuals “strategically bought dozens of medical supply companies located across the United States,” then used the stolen identities of over a million Americans to submit fraudulent Medicare claims for “urinary catheters and other durable medical equipment.”
In another case, foreign individuals relied on artificial intelligence to carry out identity theft.
“The defendants allegedly used artificial intelligence to create fake recordings of Medicare beneficiaries purportedly consenting to receive certain products,” the Justice Department says. The recordings were then “sold to laboratories and durable medical equipment companies, which used this unlawfully obtained and fraudulently generated data to submit false claims to Medicare.”
So far, the government has recovered $44.7 million of the $418 million paid on these claims.
Other defendants allegedly submitted fraudulent claims for unnecessary amniotic wound grafts, targeting elderly patients and receiving “millions in illegal kickbacks from the fraudulent billing scheme.”
Agency and department heads affirmed their commitment to rooting out health care fraud schemes, emphasizing how they harm patients and Americans.
The schemes “often result in physical patient harm through medically unnecessary treatments or failure to provide the correct treatments,” said Matthew R. Galeotti, Head of the Justice Department’s Criminal Division, adding that medical fraudsters steal “ money hardworking Americans contribute to pay for the care of their elders and other vulnerable citizens.”
“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.”
