Health care fraud enforcement is evolving rapidly in 2025. The Department of Justice (DOJ) has recommitted to its oversight of fraud and abuse in government-funded health programs. As part of its toolkit, artificial intelligence is increasingly used to detect suspicious billing patterns. And as investigations increase, health care providers are seeing heightened scrutiny...
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How to report healthcare fraud the right way
Healthcare fraud takes a toll on patients, taxpayers, and public programs like Medicare and Medicaid. In Georgia, it can also affect state-run systems such as PeachCare for Kids® and the State Health Benefit Plan. If you’ve witnessed suspicious billing, unnecessary testing, or illegal kickbacks, it’s natural to wonder how and where to report healthcare...
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A guide to the largest healthcare fraud case in history
In June 2025, the Department of Justice announced the largest healthcare fraud case in U.S. history. It was a sweeping national crackdown that led to charges against 324 people, including nearly 100 doctors, nurses, pharmacists, and other licensed professionals.
The scale of the operation was unprecedented. Investigators uncovered over $14.6 billion in fraudulent claims to...
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Physician fraud cases in 2025 and their outcomes
2025 has seen several notable physical fraud cases, and the year isn't over yet. Some of these cases have been handled through civil settlements and others have been prosecuted criminally. One involved a Texas pain management physician alleged to have falsified billings for neurostimulator procedures; another one involved a Michigan physician who received a...
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Houston to the Headlines: Surge in Healthcare Fraud Prosecutions—Are You Prepared?
In what the U.S. Department of Justice (DOJ) calls the largest healthcare fraud crackdown in its history, more than 320 people across the country are now facing charges. The DOJ and other federal agencies are using new tools to track suspicious billing and identify fraudulent claims. If you work in healthcare, even in a...
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The $14.6 billion health care fraud crackdown: what it means for providers
In 2025, the Department of Justice (DOJ) announced the largest health care fraud takedown in U.S. history. This sweeping operation uncovered $14.6 billion in intended losses due to schemes ranging from opioid trafficking to fraudulent medical equipment billing. Over 320 defendants were charged, including doctors, pharmacists, and even international crime organizations. While the...
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FCA Enforcement Expands: DOJ Expands Focus on Fraud in Government Contracting and Higher Education
The Department of Justice (DOJ) is reimagining how it enforces the False Claims Act (FCA), and federal contractors, colleges, and universities should take note of this development.
In May 2025, the DOJ launched the Civil Rights Fraud Initiative, a bold strategy that links the administration’s view of civil rights contracting compliance to financial crimes. For...
When Innovation Becomes Exploitation: Inside the $1B Healthcare Fraud Case
Technology has transformed the way healthcare operates, for the better in many cases. But when that innovation is used to exploit vulnerable patients, it can lead to serious consequences.
That’s what happened in one of the largest healthcare fraud schemes in U.S. history. The CEO of Power Mobility Doctor...
The U.S. is suing major health insurers over kickbacks in landmark False Claims Act case
The U.S. Department of Justice filed a lawsuit in May against three of the country’s largest private health insurers for violating the False Claims Act, specifically in the form of “kickbacks.” Hundreds of insurance brokers at eHealth, GoHealth, and SelectQuote are accused of engaging in a far-reaching kickback scheme with CVS Health, Aetna, Elevance...
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DEI and the False Claims Act: Navigating the New Political Landscape
The intersection of Diversity, Equity, and Inclusion (DEI) initiatives and the False Claims Act (FCA) has become a focal point in the evolving political and legal landscape under the Trump Administration. Recent executive orders and legal challenges have introduced complexities for organizations, especially those receiving federal funds. Understanding these developments is crucial for businesses...