Federal investigators are watching wound care billing practices closely because Medicare and Medicaid costs linked to debridement, wound repair, and skin substitutes have risen in recent years. Providers who bill these services need to know that the Office of Inspector General (OIG) and the Department of Justice (DOJ) are reviewing these claims more often,...

James Carthron, M.D., 61, of Saginaw, Michigan, faces 23 Medicaid criminal charges alleging fraudulent Medicaid billing for virtual visits that reportedly did not occur. The Attorney General’s Health Care Fraud Division announced that each count could lead to financial penalties and up to four years in prison if he is convicted....

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...

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...

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...

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...

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...

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...

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. 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...