The Department of Justice (DOJ) announced sweeping charges on Monday against more than 300 defendants accused of deceiving patients into paying for, or receiving, unnecessary medical treatments. DOJ Criminal Division chief Matthew Galeotti said the scheme also aimed to defraud Medicare and other taxpayer-funded and private health insurance programs of approximately $14.6 billion.
“This marks the largest coordinated healthcare fraud takedown in the history of the Department of Justice,” Galeotti declared at a press conference.
A DOJ press release revealed that 29 individuals were charged with alleged connections to transnational criminal organizations, submitting over $12 billion in false claims to U.S. health insurance programs.
Another 74 individuals, including 44 licensed medical professionals, were indicted across 58 cases for allegedly distributing 15 million opioid pills and other controlled substances. Among them, five individuals tied to a Texas pharmacy are accused of unlawfully dispensing over 3 million pills of opioids like oxycodone, hydrocodone, and carisoprodol, which were then sold on the streets.
Further, 49 defendants were charged with submitting more than $1.17 billion in fraudulent Medicare claims. An additional 170 individuals face charges for various schemes involving $1.84 billion in false claims to Medicare, Medicaid, and private insurers for diagnostic tests, medical visits, and unnecessary treatments, often in exchange for kickbacks and bribes.
Attorney General Pamela Bondi emphasized the scale of the crackdown: “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.”
In one chilling case, three defendants in Arizona allegedly conspired to apply medically unnecessary skin grafts known as “amniotic wound allografts” on elderly Medicare recipients, including terminally ill hospice patients. One nurse practitioner reportedly performed the procedure on patients just days from death, despite its invasive nature. Galeotti called it part of a broader $1 billion fraud scheme that robbed patients of “dignity and peace” in their final days.
A DOJ official identified skin graft scams as an emerging fraud trend, with providers billing over $1,000 per square centimeter.
The DOJ’s release outlined the breadth of the operation, spanning the U.S. and involving 324 individuals. Defendants include medical professionals, 25 of whom are doctors, as well as medical supply company owners.
One operation, dubbed “Operation Gold Rush,” targeted a transnational criminal network that allegedly laundered $10 billion through a scheme involving catheters. Authorities say the perpetrators used stolen identities and confidential health data to file false Medicare claims. Nineteen individuals were indicted, with twelve arrests already made, including four in Estonia and seven at U.S. entry points.
The DOJ’s healthcare fraud unit led the initiative, with Galeotti announcing the launch of a new “fusion center” to streamline data-sharing among agencies investigating healthcare fraud.
Dr. Mehmet Oz, Administrator of the Centers for Medicare and Medicaid Services, joined Galeotti at the press conference to urge the public to report fraud. “We need your help,” Oz said. “Over half of the fraud against our government is in healthcare.”
The DOJ reiterated its commitment to combating abuse in the healthcare system and called on whistleblowers to come forward with information that could aid ongoing investigations.
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