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 Medicare, Medicaid, and other health programs. The case (part of the 2025 National Health Care Fraud Takedown) involved enforcement actions in 50 federal districts and 12 state Attorneys General’s Offices across the United States.
This enforcement action more than doubled the previous record for healthcare fraud takedowns. If you’re concerned about your own exposure or need guidance on how these charges may affect your practice, a Georgia healthcare fraud lawyer at Griffin Durham Tanner & Clarkson can help you navigate the legal risks.
A nationwide takedown with federal and state coordination
The historical takedown was led by the Department of Justice’s Health Care Fraud Unit, working alongside the Office of Inspector General for Health and Human Services (HHS-OIG), the FBI, the DEA, and the Centers for Medicare & Medicaid Services (CMS). Initial investigations were supported by state law enforcement and the Medicaid Fraud Control Units of dozens of states.
These agencies worked together to investigate and charge health care fraud schemes in every corner of the country, many of which were tied to complex billing schemes, transnational criminal networks, and misuse of prescription drugs.
“This record-setting takedown delivers justice to criminal actors who prey upon our most vulnerable citizens and steal from hardworking American taxpayers,” said U.S. Attorney General Pamela Bondi.
What the investigation uncovered
Here’s a breakdown of the types of healthcare fraud the government uncovered during the largest healthcare fraud takedown:
Operation Gold Rush: A global fraud ring
One of the largest cases involved a transnational criminal organization that used stolen identities from over a million Americans to bill Medicare for $10.6 billion in fake claims, mainly for medical equipment that was never provided.
The scheme relied on overseas actors using encrypted apps and fake ownership documents to set up dozens of U.S. medical supply companies. They laundered the money through cryptocurrency and foreign shell companies. Thanks to real-time detection tools, CMS blocked all but $41 million from being paid and seized millions in assets.
Prescription drug and opioid fraud
Across 58 cases, 74 defendants were charged with illegally distributing over 15 million pills of opioids and other controlled substances. These cases revealed how pill mills and fake pharmacies continue to fuel the opioid crisis.
In one Texas case, a single pharmacy was tied to over 3 million illegal opioid prescriptions.
Telemedicine and genetic testing scams
Fraud tied to telemedicine also played a big role in the takedown. In Florida and other states, companies used telemarketing calls and fake consults to trick Medicare into paying for genetic tests and durable medical equipment patients never requested or needed. Nearly $1.17 billion in fraudulent claims were linked to this type of scheme alone.
Wound care fraud targeting the elderly
Several cases involved companies that billed Medicare for amniotic wound grafts that were medically unnecessary. These expensive procedures were performed on elderly and hospice patients, often without their doctors’ involvement and without proper infection control.
Marketing scams using AI and stolen identities
In another set of charges, defendants allegedly used AI-generated voice recordings to mimic Medicare beneficiaries consenting to services they never asked for. The fraudsters then sold that data to labs and equipment companies, which submitted hundreds of millions of dollars in false claims.
How much money was recovered?
As part of the 2025 National Health Care Fraud Takedown, the federal government:
- Seized over $245 million in cash, luxury goods, and cryptocurrency
- Blocked $4 billion in fraudulent payments before they went out
- Suspended or revoked 205 provider billing privileges
- Filed civil charges against 20 people for $14.2 million
- Reached civil settlements with 106 others totaling $34.3 million
Smarter fraud enforcement through data and analytics
What made this takedown effective was the use of data analytics and AI to spot fraud early. The DOJ’s Health Care Fraud Unit and partners from HHS, CMS, and the FBI used real-time billing data and anomaly detection to stop fraud before payments went out.
To keep that momentum going, the DOJ announced a new Health Care Fraud Data Fusion Center, which will bring together experts from across agencies to detect and respond to emerging threats more quickly.
Why this healthcare fraud case matters
Healthcare fraud isn’t a victimless crime. It drains money from Medicare and Medicaid, drives up costs, and often puts real patients in danger. In many cases, patients were subjected to unnecessary treatments or substandard care as part of these schemes.
This takedown shows how serious the federal government is about protecting these programs.
As FBI Director Kash Patel said, “Those who exploit the system for personal gain will be held accountable.”
What to do if you suspect fraud
If you work in healthcare and see something suspicious, like billing for services that weren’t provided or patients being pushed into unnecessary treatment, you have the right to report suspected fraud.
Agencies like the Department of Health and Human Services and the Department of Justice accept tips and complaints from all sources. You can remain anonymous, or you can file a whistleblower claim under the False Claims Act and potentially receive part of any government recovery.
Here’s where to report:
- HHS Office of Inspector General: HHS OIG Hotline | 1-800-HHS-TIPS
- FBI Internet Crime Center: ic3.gov
Facing an investigation? Don’t wait.
If you’re a provider or healthcare business owner and federal investigators have contacted you, or you’re concerned about past billing practices, make it a priority to speak with an attorney.
At Griffin Durham Tanner & Clarkson LLC, we represent professionals across Georgia who are under investigation for alleged Medicare or Medicaid fraud, facing whistleblower actions, or simply trying to respond to inquiries without putting themselves at risk. To get started, contact us online, call our Atlanta office at (404) 891-9150, or our Savannah office at (912) 867-9140.