More than 300 charged in $14.6 billion health care fraud schemes

Healthcare Fraud Takedown: 324 Defendants Charged in $14.6 Billion Scheme

Federal and state prosecutors have announced the largest healthcare fraud enforcement action in U.S. history, charging more than 320 individuals in schemes totaling over $14.6 billion

June 30, 2025

WASHINGTON — The U.S. Department of Justice announced Monday the results of its 2025 National Health Care Fraud Takedown, resulting in criminal charges against 324 defendants across the United States in what officials called the largest coordinated healthcare fraud enforcement action in American history.

The operation resulted in criminal charges against 324 defendants, including 96 doctors, nurse practitioners, pharmacists, and other licensed medical professionals, in 50 federal districts and 12 State Attorneys General's Offices across the United States, for their alleged participation in various health care fraud schemes involving over $14.6 billion in intended loss.

The massive enforcement effort more than doubles the previous record of $6 billion and represents an unprecedented effort to combat health care fraud schemes that exploit patients and taxpayers. Law enforcement agencies seized over $245 million in cash, luxury vehicles, cryptocurrency, and other assets as part of the coordinated operation.

Operation Gold Rush: The $10.6 Billion Catheter Scheme

The centerpiece of the takedown was Operation Gold Rush, described as the largest healthcare fraud case ever charged by the Department of Justice. 19 defendants were charged in connection with a $10.6 billion scheme involving urinary catheters and other durable medical equipment, with arrests spanning multiple countries.

Twelve of these defendants have been arrested, including four defendants who were apprehended in Estonia as a result of international cooperation with Estonian law enforcement and seven defendants who were arrested at U.S. airports and the U.S. border with Mexico, cutting off their intended escape routes as they attempted to avoid capture.

The sophisticated international conspiracy allegedly used a network of foreign straw owners, including individuals sent into the United States from abroad, who, acting at the direction of others using encrypted messaging and assumed identities from overseas, strategically bought dozens of medical supply companies located across the United States.

Beginning in late 2022, the companies collectively submitted fraudulent claims to Medicare for more than 1 billion urinary catheters, exploiting the stolen identities of over one million Americans across all 50 states. HHS-OIG and CMS successfully prevented the organization from receiving all but approximately $41 million of the approximately $4.45 billion that was scheduled to be paid by Medicare.

Transnational Criminal Networks Target U.S. Healthcare

The investigation revealed the growing involvement of transnational criminal organizations in healthcare fraud. 29 defendants were charged for their roles in transnational criminal organizations alleged to have submitted over $12 billion in fraudulent claims to America's health insurance programs.

In one case filed in the Northern District of Illinois, charges were filed against five defendants, including two owners and executives of Pakistani marketing organizations, in connection with a $703 million scheme in which Medicare beneficiaries' identification numbers and other confidential health information were allegedly obtained through theft and deceptive marketing. The defendants allegedly used artificial intelligence to create fake recordings of Medicare beneficiaries consenting to receive products.

Another defendant based in Pakistan and the United Arab Emirates allegedly orchestrated a scheme to defraud Arizona Medicaid of approximately $650 million by billing for substance abuse treatment services that were either never provided or so substandard they served no treatment purpose.

Telemedicine and Genetic Testing Fraud

49 defendants were charged in connection with the submission of over $1.17 billion in allegedly fraudulent claims to Medicare resulting from telemedicine and genetic testing fraud schemes. These schemes typically involved targeting Medicare beneficiaries through deceptive telemarketing campaigns for genetic tests and durable medical equipment that were not medically necessary.

The Justice Department has been increasingly focused on genetic testing fraud, with previous enforcement actions in 2019 and earlier in 2025 targeting similar schemes. In February 2025, 35 defendants were charged in connection with over $2.1 billion in fraudulent genetic cancer testing schemes.

Prescription Drug Trafficking

The takedown also targeted the illegal diversion of prescription opioids. 74 defendants, including 44 licensed medical professionals, were charged across 58 cases in connection with the alleged illegal diversion of over 15 million pills of prescription opioids and other controlled substances.

One Texas pharmacy operation was charged with unlawfully distributing over 3 million opioid pills, with the defendants allegedly conspiring to distribute massive quantities of oxycodone, hydrocodone, and carisoprodol that were subsequently trafficked by street-level drug dealers.

Government Response and Prevention Efforts

Attorney General Pamela Bondi emphasized the administration's commitment to combating healthcare fraud. "This record-setting Health Care Fraud Takedown delivers justice to criminal actors who prey upon our most vulnerable citizens and steal from hardworking American taxpayers," Bondi said in a statement. "Make no mistake – this administration will not tolerate criminals who line their pockets with taxpayer dollars while endangering the health and safety of our communities."

Health and Human Services Secretary Robert F. Kennedy Jr. added that "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."

The enforcement action was coordinated by the Health Care Fraud Unit of the Justice Department's Criminal Division's Fraud Section, working with U.S. Attorneys' Offices, the Department of Health and Human Services Office of Inspector General, the FBI, and the Drug Enforcement Administration.

New Data Analytics Initiative

As part of the operation, the Justice Department announced the creation of a Health Care Fraud Data Fusion Center to leverage cloud computing, artificial intelligence, and advanced analytics to identify emerging health care fraud schemes. The initiative implements President Trump's executive order on eliminating information silos in government operations.

The Health Care Fraud Unit's Data Analytics Team and its partners detected the anomalous billing through proactive data analytics, demonstrating the effectiveness of using advanced technology to identify fraudulent patterns before payments are made.

Impact on Healthcare Costs

Dr. Mehmet Oz, Administrator of the Centers for Medicare and Medicaid Services, noted that "These are organized syndicates who are designing to hurt America." The fraudulent schemes not only steal taxpayer money but also drive up healthcare costs for all Americans and can endanger patient safety through unnecessary or inappropriate medical procedures.

CMS announced that it successfully prevented over $4 billion from being paid in response to false and fraudulent claims and suspended or revoked the billing privileges of 205 providers in the months leading up to the takedown.

Financial Impact and Recovery Efforts

The massive fraud schemes have had significant financial impacts across the healthcare system, affecting Medicare, private insurers, healthcare providers, and patients in different ways.

Medicare and Taxpayer Impact

HHS-OIG and CMS successfully prevented the organization from receiving all but approximately $41 million of the approximately $4.45 billion that was scheduled to be paid by Medicare in Operation Gold Rush alone. HHS and CMS intend to seek to return the $4.41 billion in escrow to the Medicare trust fund for needed medical care.

However, the broader impact on American taxpayers is substantial. Taxpayers are losing more than $100 billion a year to Medicare and Medicaid fraud, according to estimates from the National Health Care Anti-Fraud Association. This fraud directly threatens the stability of Medicare, which is projected to run out of money in 2033 — or three years earlier than analysts thought in their 2024 review.

Private Insurance Losses

While Medicare was largely protected from the Operation Gold Rush scheme, private insurers suffered significant losses. The scheme nonetheless resulted in payments of approximately $900 million from Medicare supplemental insurers - insurance companies that help cover older Americans' healthcare costs beyond basic Medicare coverage.

This $900 million loss to supplemental insurers demonstrates how fraud schemes can shift costs from government programs to private insurers, ultimately affecting premiums for all Americans. The perpetrators, authorities allege, were still able to collect about $1 billion in payments from other insurance companies that help cover older Americans' health care costs, known as Medicare supplemental insurers.

Impact on Healthcare Providers

The fraud schemes have also affected legitimate healthcare providers in unexpected ways. It frustrated accountable-care organizations — groups of hospitals and physicians that receive federal incentives to deliver high-quality, low-cost health care — which worried that they could collectively lose millions of dollars in payments because it appeared they were failing to manage their patients' health care spending.

CMS subsequently issued new rules to protect these legitimate healthcare organizations from being penalized for the fraudulent catheter billing that appeared to show excessive healthcare spending by their patients.

Patient Harm

Beyond financial losses, these schemes directly harm patients. Gerald Quindry was one of more than 1 million Americans whose personal information was compromised in an alleged $10.6 billion fraud scheme, receiving statements for $15,500 in urinary catheters he never ordered or received.

Such identity theft can result in incorrect medical records, affecting future care, and patients may face difficulties accessing legitimate services when their Medicare benefits appear to have been exhausted by fraudulent claims.

Government Recovery Efforts

Law enforcement has had significant success in recovering stolen funds. To date, law enforcement has seized approximately $27.7 million in fraud proceeds as part of Operation Gold Rush. Across all healthcare fraud enforcement efforts, during FY 2023, efforts by the Health Care Fraud and Abuse Control Program for Medicare, Medicaid, and other government programs resulted in recoveries of $3.4 billion, of which the Medicare Trust Funds received close to $1 billion.

The government's return on investment in fraud fighting is substantial: The ROI for the HCFAC program from 2021 to 2023 is $2.80 returned for every $1.00 expended toward addressing fraud and abuse.

Prevention Over Recovery

The 2025 takedown demonstrates a shift in government strategy from reactive recovery to proactive prevention. Federal officials were successfully able to prevent more than 99 percent of the Medicare payments from reaching the alleged perpetrators, saying that teams at the Centers for Medicare and Medicaid Services and HHS inspector general's office moved quickly to identify fraudulent bills, suspend payments to the suspected companies and work with law enforcement.

This represents a move away from the traditional "pay and chase" approach — where agencies would pay out claims before identifying fraud and then try to claw the money back — to a "stop and caught" model.

Looking Forward

The 2025 takedown brings the total number of defendants charged by Health Care Fraud Strike Forces to more than 5,400 since the program's inception in March 2007, with collective billing of more than $27 billion to Medicare, Medicaid, and private health insurers.

The cases are being prosecuted across all 50 states, demonstrating the nationwide scope of healthcare fraud and the coordinated federal response to combat these schemes that exploit vulnerable patients and drain resources from legitimate healthcare programs.

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Sources

1. U.S. Department of Justice. "National Health Care Fraud Takedown Results in 324 Defendants Charged in Connection with Over $14.6 Billion in Alleged Fraud." Office of Public Affairs. June 30, 2025. https://www.justice.gov/opa/pr/national-health-care-fraud-takedown-results-324-defendants-charged-connection-over-146
2. Centers for Medicare & Medicaid Services. "National Health Care Fraud Takedown Results in 324 Defendants Charged in Connection with Over $14.6 Billion in Alleged Fraud." CMS Newsroom. June 30, 2025. https://www.cms.gov/newsroom/press-releases/national-health-care-fraud-takedown-results-324-defendants-charged-connection-over-146-billion
3. U.S. Department of Health and Human Services Office of Inspector General. "2025 National Health Care Fraud Takedown." June 30, 2025. https://oig.hhs.gov/newsroom/media-materials/2025-national-health-care-fraud-takedown/
4. Richer, Alanna Durkin. "More than 300 charged in $14.6 billion health care fraud schemes takedown, Justice Department says." Associated Press. June 30, 2025. https://www.sandiegouniontribune.com/2025/06/30/justice-department-health-care-fraud/
5. The Washington Post. "Inside Operation Gold Rush, largest health care fraud bust in U.S. history." June 30, 2025. https://www.washingtonpost.com/health/2025/06/30/health-care-fraud-bust-largest-in-us-history/
6. U.S. Department of Justice. "Federal Law Enforcement Action Involving Fraudulent Genetic Testing Results in Charges Against 35 Individuals Responsible for Over $2.1 Billion in Losses in One of the Largest Health Care Fraud Schemes Ever Charged." February 6, 2025. https://www.justice.gov/archives/opa/pr/federal-law-enforcement-action-involving-fraudulent-genetic-testing-results-charges-against
7. Tampa Free Press. "Billion-Dollar Bust: DOJ Unveils Largest Healthcare Fraud Takedown In U.S. History." June 30, 2025. https://www.tampafp.com/billion-dollar-bust-doj-unveils-largest-healthcare-fraud-takedown-in-u-s-history/
8. The Washington Post. "11 Eastern Europeans charged in $10.6 billion Medicare fraud scheme." June 26, 2025. https://www.washingtonpost.com/health/2025/06/26/medicare-fraud-scheme-uncovered/

More than 300 charged in $14.6 billion health care fraud schemes