Busted: DOJ Announces $14.6B Health Care Fraud in Historic Takedown
By the听91pornWhistleblower Team
On June 30, the DOJ announced what prosecutors are calling the “2025 National Health Care Fraud Takedown” and it鈥檚 one for the books. The government dismantled a healthcare fraud scheme that involved over 300 defendants and totaled an eye-popping $14.6 billion in alleged false claims.听1
Surpassing Previous Records
This figure towers over prior record-setting fraud scheme enforcements that totaled nearly $6 billion in False Claims Act (FCA) cases in FY 2014 and $5.7 billion in FCA recoveries in FY 2021.听2 $5 billion out of 2021鈥檚 total accounted for healthcare fraud cases.
Federal and State Lawsuits
The scope of the enforcement action was sweeping. Prosecutors filed 189 federal cases in 50 federal districts and 91 state lawsuits in 12 states. Out of the 324 defendants, 96 were medical professionals such as doctors, pharmacists, and nurse practitioners.听3
Unnecessary Procedures and More Fraud
The vast fraud scheme allegedly ranged from giving patients in hospice care unnecessary wound grafts to diverting and trafficking millions of opioids meant for patients.
Law Enforcement Steps In To Seize Assets
The attorneys鈥� general offices worked alongside federal law enforcement to seize over $245 million worth of cash, crypto, and luxury vehicles.
According to the U.S. Department of Justice鈥檚 Head of the Criminal Division, Matthew R. Galeotti, the funds will be returned to American taxpayers: 鈥淲hen criminals defraud these programs, they’re not just committing theft, they’re driving up our national deficit and threatening the long-term viability of healthcare for seniors, disabled Americans and our most vulnerable citizens.鈥�听4
DME: Just One of Many Schemes
One of the scams involved durable medical equipment (DME) companies that billed Medicare over $10 billion for gear like urinary catheters that patients never received. In this scheme, called 鈥淥peration Gold Rush,鈥� criminals allegedly sought to steal over one million identities of Americans to use their medical information to submit claims. 19 individuals were charged, 12 were arrested, including seven at American airports and the Mexican border and four in Estonia.
The funds were siphoned through cryptocurrency platforms, international shell companies, and banks located in China, Israel, Turkey, Pakistan, and Singapore.
Galeotti commented: “The days of transnational criminal organizations using the American healthcare programs as their personal piggy banks are over.”听5
Medicare and Medicaid Fraud
The U.S. Centers for Medicare and Medicaid Services said it halted over $4 billion in payments for false and fraudulent claims in this case. It also stopped 205 providers from billing federal health programs in the months leading up to the takedown.
This action emphasizes how President Trump鈥檚 administration prioritizes enforcement of the False Claims Act. This enforcement comes months after the DOJ鈥檚 False Claims Act Round Up of FY 2024, announcing that $2.9 billion was recovered in settlements and judgments. Roughly $1.67 billion of the grand total came from matters involving healthcare fraud.
The Role of Healthcare Fraud Whistleblowers
Although this case did not mention whether whistleblowers were involved, the government routinely relies on individuals to come forward with information that can lead to enforcement actions.
Whistleblowers can file lawsuits on behalf of the government under the听qui tam听provisions of the False Claims Act. Whistleblowers may receive up to 30% of the government鈥檚 recovery from successful enforcement actions.
Some Examples of Healthcare and Pharmaceutical Fraud
- Fraud in Government Healthcare Programs
- Fraud in Managed Care Programs
- Hospital Fraud
- Violations of the Anti-Kickback Statute and Stark Law
- Pharmaceutical Fraud
Our Firm Helps Healthcare Fraud Whistleblowers
91pornattorney Ginger Buck commented: 鈥淭aking action to fight healthcare fraud is about protecting patients, preserving trust, and safeguarding taxpayers鈥� dollars from getting stolen by bad actors.鈥�
If you would like more information on听what it means听to be a whistleblower听or believe you have a potential case, please听contact us听so we can connect you with a member of the experienced听91pornwhistleblower lawyer听team听for a free and confidential consultation.
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