Dive Brief:
The Justice Department has brought criminal charges against 324 people — including nearly 100 doctors, nurse practitioners, pharmacists and other healthcare professionals — in what it says is the largest coordinated sting on healthcare fraud to date.
The operation involved uncovering $14.6 billion in false claims, more than double the agency’s largest prior recovery of $6 billion, DOJ and CMS officials told reporters Monday. Officials are gearing up for even stronger enforcement efforts.
The DOJ unveiled a “healthcare data fusion center” on Monday that will use technology to detect, investigate and prosecute healthcare fraud, while CMS Administrator Dr. Mehmet Oz said his agency is standing up a similar “war room” to prevent cyberattacks that lead to fraud.
Dive Insight:
The massive fraud take down involved cooperation between the DOJ’s criminal division, the HHS’ Office of Inspector General, the FBI and the Drug Enforcement Administration.
In total, officials seized more than $245 million in cash, luxury vehicles, cryptocurrency and other assets during the operation. Actual losses to the government were about $2.9 billion, officials said. Defendants run the gamut of transnational criminals organizations, telemedicine CEOs, pharmacists and wound care providers, according to a DOJ press release.
The operation, dubbed the 2025 National Health Care Fraud Takedown, comes amid a yearslong, bipartisan push to rein in healthcare fraud.
The healthcare industry has consistently been disproportionately represented in its number of annual False Claims Act settlements when compared to other sectors. Last year, for example, settlements and judgments involving healthcare accounted for more than half of the DOJ’s total FCA enforcement activity.
There’s an even stronger imperative to tackle the problem this year, after President Donald Trump signed an executive order in March directing agencies to work together to root out fraud, waste and abuse. On Monday, Oz said that cross-agency collaboration observed in this operation was “exactly what [the president] had in mind.”
The government, like healthcare companies in the private sector, is also struggling to respond to the growing threat of cyberattacks. Officials said public health programs are a ripe target for cyber criminals, pushing them to shore up their defenses.
“Right now, there’s hundreds of thousands, probably millions, of efforts being made to hack into CMS,” said Oz. “There are modern tools being used to attack us, and we need even more modern ways, including AI … to take them down. The oversight has to be unrelenting.”
Officials pointed to the recent operation as evidence that, although they can’t stop bad actors from trying to perpetuate fraud, they might be able to mitigate the worst harms.
In a scheme called “Operation Gold Rush,” officials said international criminals had attempted to use stolen data from millions of Americans to rapidly submit more than $10 billion in fraudulent claims to Medicare. The DOJ’s healthcare fraud unit detected anomalous billing through advanced data analytics and alerted HHS, so that the criminals were only able to receive about $41 million of approximately $4.5 billion scheduled Medicare payments.
Still, the case points to a “disturbing trend” of increasingly sophisticated attacks, according to Matthew Galeotti, head of the Justice Department’s criminal division. He said the new healthcare data fusion center will help the government better investigate healthcare fraud and break down inter-agency silos to enable faster response times.
The goal is to discover attempted fraudulent activity before it occurs, with Oz noting that once foreign actors defraud the programs the money is often “offshore” and out of reach.
Oz also implored Americans to report any fraudulent activity they encounter, touting the statistic that up to 25% of healthcare spending nationwide could be wasteful. (The agency relied on the same statistic to justify adding prior authorization for some Medicare services a few days prior.)
“We need your help, the American people,” Oz said. “Why? Over half of the whistleblower tips that we get are for healthcare fraud and over half of the fraud against our government is in healthcare.”
