DOJ indicts 324 individuals in $14.6 billion Medicare and Medicaid healthcare fraud

• The Department of Justice (DOJ) charged 324 individuals, including 96 medical professionals, in a nationwide healthcare fraud operation involving $14.6 billion in false claims to Medicare, Medicaid and other programs.
• Authorities seized over $245 million in assets and prevented more than $4 billion in fraudulent Medicare payouts. CMS revoked or suspended billing privileges for 205 providers, with civil charges and settlements totaling nearly $50 million.
• The largest case, dubbed Operation Gold Rush, exposed a $10.6 billion transnational fraud ring that used stolen U.S. identities and shell companies to bill Medicare for medical supplies, resulting in arrests in five districts and seizures of $27.7 million.
• Cases included AI-generated consent scams in Illinois, Medicaid fraud exploiting the homeless and Native Americans in Arizona, a $1.1 billion wound care kickback scheme, diversion of 15 million opioid pills and $1.17 billion in telehealth fraud.
• Officials stressed the human impact, unnecessary procedures, improper prescriptions and denied care, highlighting the ongoing commitment to protect patients, stop abuse of public health funds and restore trust in the system.

The Department of Justice (DOJ) has announced charges against 324 individuals, including 96 licensed medical professionals, across 50 federal districts and 12 State Attorneys General’s Offices for orchestrating $14.6 billion in fraudulent claims to Medicare, Medicaid and other government healthcare programs.

The coordinated takedown, spearheaded by the DOJ’s Health Care Fraud Unit, involved extensive collaboration with the Department of Health and Human Services (HHS) – Office of Inspector General (OIG), Federal Bureau of Investigation (FBI), Drug Enforcement Administration (DEA), Centers for Medicare and Medicaid Services (CMS) and multiple federal and state partners, seized over $245 million in cash, luxury goods and cryptocurrency and prevented more than $4 billion in Medicare payments tied to fraudulent claims.

CMS also revoked or suspended 205 providers’ billing privileges in the months leading up to the crackdown. Civil actions were also prominent: 20 defendants face $14.2 million in civil fraud charges, while 106 defendants reached civil settlements totaling $34.3 million.

Among the most notable investigations was Operation Gold Rush, a transnational scheme described by the DOJ as the largest healthcare fraud case by intended loss in U.S. history. Nineteen defendants were charged in five districts, with 12 arrested – including four in Estonia – through international cooperation and seven at U.S. ports of entry.

According to court documents, the criminal network acquired dozens of U.S.-based medical supply companies through foreign operatives and used stolen identities of over one million Americans to submit $10.6 billion in false claims for urinary catheters and durable medical equipment. Though only $41 million was paid out before detection, Medicare supplemental insurers still disbursed $900 million. Law enforcement has seized $27.7 million from the scheme thus far.

In Illinois, five individuals, including Pakistani executives, were charged for using AI-generated fake audio recordings and stolen identities to submit $703 million in false Medicare claims, with $418 million paid out before detection. (Related: DOJ announces biggest healthcare fraud and opioid takedown in its history.)

In Arizona, a Pakistan- and UAE-based billing executive was charged in a $650 million Medicaid fraud case that allegedly exploited vulnerable populations for sham addiction treatments, laundering $25 million and purchasing a $2.9 million estate in Dubai. In Arizona and Nevada, seven individuals, including five licensed professionals, were charged in a $1.1 billion wound care scam involving unnecessary procedures on elderly patients and kickbacks. Separately, 74 defendants were charged with illegally diverting more than 15 million opioid pills, exacerbating the national crisis.

Telehealth fraud also played a major role, with 49 defendants linked to $1.17 billion in fake Medicare claims, including a $46 million genetic testing scheme in Florida. Additional charges against 170 defendants involved $1.84 billion in losses across various schemes nationwide, including fraudulent billing in Tennessee and drug theft in Washington and California. The DEA also initiated 93 actions to revoke controlled substance licenses from pharmacies and providers involved.

Authorities vow continued vigilance to root out healthcare fraud

Officials emphasized that the financial losses are only part of the picture. The schemes often resulted in real-world harm, including medically unnecessary procedures, improper prescriptions contributing to the opioid crisis and denial of appropriate care to patients.

“The scale of today’s Takedown is unprecedented, and so is the harm we’re confronting. Individuals who attempt to steal from the federal health care system and put vulnerable patients at risk will be held accountable,” said Acting Inspector General Juliet T. Hodgkins of HHS-OIG on Monday, June 30.

FBI Director Kash Patel echoed those concerns, calling the operation the “largest takedown for this initiative to date.”

“Health care fraud drains critical resources from programs intended to help people who truly need medical care,” Patel said. “Today’s announcement demonstrates our commitment to pursuing those who exploit the system for personal gain.”

“This is about protecting the integrity of our health care programs and ensuring that taxpayer dollars go toward healing, not harm,” said Matthew R. Galeotti, head of the DOJ Criminal Division. “Health care fraud doesn’t just rob from the public, it risks lives and fuels crises like the opioid epidemic.”

HHS Secretary Robert F. Kennedy Jr. added, “As part of making health care accessible and affordable to all Americans, HHS will aggressively work with our law enforcement partners to eliminate the pervasive health care fraud that bedeviled this agency under the former administration and drove up costs.”

Visit BadDoctors.news for more news related to crooked medical practitioners.

Watch the video below that talks about America’s insurance fraud-based economy.

This video is from The New American channel on Brighteon.com.

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Sources include:

YourNews.com

justice.gov

Brighteon.com