Federal authorities charge hundreds in record-breaking health care fraud enforcement effort.
The Department of Justice recently announced the largest health care fraud enforcement action to date, marking a major milestone in its ongoing work against fraud. This sweep charged hundreds of individuals, including nearly one hundred health professionals, in connection with schemes involving more than $14 billion in intended losses. That figure, while enormous, represents the total amount that could have been lost if fraudulent claims had been paid. It includes money never actually spent, which shows how much was at risk rather than how much was stolen. Still, the number points to the massive scale of efforts to exploit the health care system.
Government officials say this largest fraud crackdown sends a strong message about stopping fraud before it gets started. The federal agencies involved not only filed criminal charges, but also froze millions in assets, including cash, luxury goods, and digital currency. Over four billion dollars in claims were blocked, and civil cases were filed or settled for hundreds of millions more. Charges were brought for everything from unnecessary tests and equipment to kickback schemes and fake patient records. The focus remains on both stopping theft and recovering money wherever possible.
As in past crackdowns, this year’s enforcement touched on many familiar issues. Opioid fraud remains a concern, as do schemes involving COVID-19 treatments, genetic testing, and telehealth services. Investigators used data tools to spot strange patterns in billing and looked for links to broader criminal networks to initiate its largest takedown. One such operation, called Gold Rush, targeted groups tied to international crime. The charges connected to that effort alone involved more than $12 billion in false claims, making it the largest amount ever alleged in a single health care case.
Some of the newer schemes show how technology is being used to trick the system. In one case, scammers created audio clips using artificial intelligence to pretend patients had agreed to receive medical equipment. They combined these fake recordings with stolen Medicare information and passed it along to companies that billed the government. Other efforts focused on wound care, with companies allegedly billing Medicare for treatments that patients did not need. Though the methods may change, the goal in each case was to collect as much money as possible without delivering real care.
Alongside these actions, the Justice Department introduced a new group focused on enforcing the False Claims Act. This law allows the government to go after people and companies that knowingly submit false claims for payment. The group includes staff from several agencies who will work together to speed up investigations and share information more easily. It also plans to look at how health records systems might be misused to increase billings and will explore ways to detect patterns in patient data that could reveal wrongdoing.
Several areas have been listed as top priorities for the new group. These include improper payments in Medicare Advantage plans, problems with drug and medical device pricing, and kickbacks disguised as rebates or service fees. The group will also watch for defective medical products and situations where technology is used to make it seem like care was delivered when it wasn’t. Investigators are expected to take a more active role in these areas, rather than relying mainly on whistleblowers to bring cases forward.
The report makes it clear that health care fraud continues to evolve. But it also shows that federal enforcement is adapting quickly to keep up. Whether by spotting odd billing through computer programs or tracking how patient data is used, agencies are working together to stop fraud from slipping through the cracks. And while some cases involve new tools and actors, the core problem remains the same: people trying to get paid for care that either wasn’t needed or wasn’t provided at all. The latest efforts show a broad push to stop those actions before they reach the bank.
Sources:
DOJ 2025 National Health Care Fraud Takedown was Record-Breaking
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