The U.S. Department of Justice (DOJ) has announced its largest-ever coordinated healthcare fraud takedown, charging 324 individuals, including 96 doctors, nurses, and other licensed medical professionals, across the country. The alleged schemes involved nearly $14.6 billion in fraudulent claims to federal healthcare programs such as Medicare and Medicaid, with actual estimated losses of around $2.9 billion.
There are approximately 66,000,000 Medicare beneficiaries, and 80 million on Medicaid or Children’s Health Insurance Program (CHIP). There are another 20 million people on the exchanges that could be affected by this fraud.
The DOJ, working alongside the Department of Health and Human Services (HHS) and other federal agencies, successfully blocked most of these fraudulent payments, preventing billions in losses. Authorities also seized over $245 million in cash, luxury items, and other assets connected to the schemes. The DOJ stated, “We’ve moved from ‘pay-and-chase’ to ‘stop-and-catch’—CMS and HHS‑OIG teams swiftly identified fraud, suspended payments, and seized tens of millions.”
A major portion of the fraud — known as Operation Gold Rush — centered on a transnational network involving Eastern European and Russian groups. These criminals allegedly used stolen identities of over 1 million Americans and acquired more than 30 U.S.-based medical supply companies to submit massive false claims for items such as urinary catheters and glucose monitors. In total, these companies alone tried to bill Medicare for more than 1 billion unnecessary devices.
This sweeping operation highlights both the scale of organized healthcare fraud and the government’s commitment to protecting taxpayer funds and patient identities. Officials emphasized ongoing efforts to strengthen oversight, including using advanced data analytics and AI tools to detect and stop fraud more effectively in the future.
Christopher Delgado is the acting deputy assistant director for the FBI’s Criminal Investigative Division that handles healthcare fraud. Here is an excerpt from the announcement that was made. “Possible health care fraud is not a victimless crime. Every dollar stolen from deceitful billing or unnecessary procedures is a dollar taken away from patients who truly need care and taxpayers who fund these critical programs”.
“Schemes like what was mentioned above drive medical costs up and strain federal healthcare budgets and ultimately impact every American who relies on Medicare, Medicaid, and other public and private insurance programs”.
“It’s also not just about financial losses. It’s about Patients being exposed to unnecessary procedures, false diagnosis and delayed care. That kind of exploitation isn’t just unethical, it’s dangerous and has no place in our healthcare system. Services that are wasteful and should not be offered to the American people because they could hurt them”.
Centers for Medicare and Medicaid Services (CMS) just launched a new model called WISeR (Wasteful and Inappropriate Service Reduction). The WISeR Model will help protect American taxpayers by leveraging enhanced technologies, such as Artificial Intelligence (AI) and Machine Learning (ML), along with human clinical review, to ensure timely and appropriate Medicare payment for select items and services. The voluntary model will encourage care navigation, encouraging safe and evidence-supported best practices for treating people with Medicare. WISeR will run for six performance years from January 1, 2026 to December 31, 2031. The application period opened on June 27, 2025.
They are asking that anyone that suspects waste, fraud, or abuse of our healthcare system to report this by calling 1-800 HHS TIPS or go to their website:
The content provided reflects the most up-to-date information available at the time of writing and should not be considered legal advice.
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