In June 2025, the Department of Justice (DOJ) announced its 2025 National Health Care Fraud Takedown, marking the largest coordinated healthcare fraud enforcement action in DOJ history. The sweep included charges against a range of actors including alleged transnational criminal organizations, providers of allegedly fraudulent wound care, alleged prescription opioid traffickers, alleged telemedicine, and genetic testing fraudsters, among others. DOJ also introduced the creation of a Health Care Fraud Data Fusion Center, designed to enhance the detection, investigation, and prosecution of healthcare fraud.
National Healthcare Fraud Takedown Results
Collaborating with federal and state partners, DOJ brought criminal charges against 324 defendants across 50 federal districts and 12 State Attorneys General Offices. These charges stemmed from $14.6 billion in alleged fraudulent and false claims submitted to Medicare, Medicaid, and other health programs. Among those charged were 96 medical professionals, including doctors, nurse practitioners, and pharmacists. Enforcement actions resulted in the seizure of over $245 million in cash, cryptocurrency, luxury vehicles, and other assets.
Of note, according to the DOJ announcement, a nationwide investigation known as Operation Gold Rush “resulted in the largest loss amount ever charged in a health care fraud case brought by the [DOJ].” As summarized in DOJ’s announcement, the transnational criminal organization at issue allegedly used a network of foreign straw owners to strategically buy dozens of medical supply companies located across the United States and “then rapidly submitted $10.6 billion in fraudulent health care claims to Medicare for urinary catheters and other durable medical equipment by exploiting the stolen identities of over one million Americans.” According to the press release, DOJ’s Health Care Fraud Unit’s Data Analytics Team “detected the anomalous billing through proactive data analytics,” preventing the “organization from receiving all but approximately $41 million of the approximately $4.45 billion that was scheduled to be paid by Medicare.”
DOJ also announced charges against 74 individuals, including 44 licensed medical professionals, for allegedly diverting over 15 million pills of prescription opioids and other controlled substances. In addition to these criminal charges, the Drug Enforcement Administration (DEA) announced that in the last six months the agency has initiated over 90 administrative actions seeking to revoke the authority of various pharmacies and medical professionals to handle or prescribe controlled substances. According to DEA Acting Administrator Robert Murphy’s press release statement, if medical professionals use their licenses “to push poison or pad [their] pockets,” the DEA will hold them accountable.
Additionally, authorities announced that 49 individuals are facing charges for their purported involvement in fraudulent schemes involving telemedicine and genetic testing. In one highlighted case, the owner of a telemedicine and medical equipment company is accused of orchestrating a $46 million scheme that allegedly targeted Medicare beneficiaries through misleading telemarketing tactics and then submitted fraudulent claims for medical equipment and genetic tests. These actions highlight DOJ’s continued focus on schemes that rely on telemedicine and the submission of fraudulent claims for genetic testing, durable medical equipment, and COVID-19 tests (additional court documents and case summaries can be found on DOJ’s website).
Looking Ahead
These enforcement actions reflect the Department’s aggressive approach toward healthcare fraud, while putting an emphasis on cross-agency collaboration. The DOJ has signaled that it will continue to prioritize the prosecution of fraudulent schemes that are seeking to exploit federal healthcare programs and have the potential to endanger patients. Matthew R. Galeotti, head of the DOJ’s Criminal Division, forecasted that “it’s the beginning of a new era of aggressive prosecution and data-driven prevention” of fraudulent healthcare schemes.
In that vein, the DOJ also announced a new collaborative operation, the Health Care Fraud Data Fusion Center, that brings together experts from the DOJ’s Health Care Fraud Unit Data Analytics Team, Federal Bureau of Investigation (FBI), the Department of Health and Human Services Office of Inspector General, and other agencies. The newly established team aims to utilize its diverse expertise in cloud computing, artificial intelligence, and analytics to detect and prevent healthcare fraud schemes while breaking down the barriers and using a more collaborative approach to increase efficiency and enhance detection of emerging schemes. Led by the DOJ’s Criminal Division, this new operation will implement Executive Order 14243 (“Stopping Waste, Fraud, and Abuse by Eliminating Information Silos”) by purportedly leveraging government resources, increasing efficiency, and reducing duplicative teams.
What This Means for You
As healthcare fraud continues to be a focus of criminal enforcement efforts, it is critical for providers and suppliers to ensure their compliance programs are up to date. Proactive steps might include: (1) reviewing compliance programs and billing practices to ensure adherence to federal and state regulations; (2) being mindful of third-party vendors and marketing partners; and (3) monitoring for unusual billing patterns.
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