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17h ago

DOJ Charges 324 in Largest-Ever $14.6 Billion Health Care Fraud Takedown

CMS is launching an AI-driven war room to detect false claims before payments are released.

FILE - The U.S. Department of Justice logo is seen on a podium before a press conference with Attorney General Pam Bondi, May 6, 2025, at the Justice Department in Washington. (AP Photo/Julia Demaree Nikhinson, File)
Dr. Mehmet Oz, administrator for the Centers for Medicare & Medicaid Services, listens as Matthew R. Galeotti, head of the Justice Department’s Criminal Division, speaks about a healthcare fraud enforcement action during a press conference at the U.S. Department of Justice in Washington, D.C., U.S., June 30, 2025. REUTERS/Kevin Lamarque
Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz joined DOJ, FBI and DEA officials for a news conference on the takedown, saying "The fact that it's even possible that you could have $15 billion to play in this endeavor is shameful." (BEN CURTIS/AP FILE)
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Overview

  • The DOJ has charged 324 individuals for schemes that sought to defraud Medicare, Medicaid and other programs of $14.6 billion, resulting in about $2.9 billion in actual losses.
  • Law enforcement has seized more than $245 million in cash, luxury vehicles, cryptocurrency and other assets from defendants in all 50 states.
  • Officials allege a range of scams including opioid trafficking, telemedicine billing fraud, genetic testing kickback schemes and identity theft networks.
  • Transnational criminal rings based in Russia, Eastern Europe and the UAE are accused of submitting over $10 billion in fraudulent Medicare claims using stolen identities.
  • CMS plans to deploy AI-powered prepayment reviews through its new fraud war room to identify and block suspicious claims before funds are disbursed.