DOJ’s Largest Crackdown Targets Doctors, Global Syndicates, and Opioid Networks
- 324 defendants charged across 50 federal districts and 12 states in record $14.6B fraud case
- 96 licensed medical professionals implicated, including doctors and pharmacists
- Feds seized over $245M in assets, including cryptocurrency and luxury goods
- CMS blocked $4B+ in false payments and suspended 205 providers
- Operation Gold Rush busted $10.6B transnational Medicare scam using 1M stolen identities
The U.S. Department of Justice (DOJ) on Monday unveiled charges against 324 defendants in what it called the largest health care fraud takedown in American history, involving more than $14.6 billion in intended losses. The sweeping operation spanned 50 federal districts and 12 state attorneys general offices, targeting an array of criminal actors from global crime syndicates to doctors accused of overprescribing opioids and billing for fake treatments.
The DOJ said that 96 licensed professionals — including physicians, nurse practitioners, and pharmacists — were among those charged in the nationwide sweep. The multi-agency effort seized over $245 million in illicit assets, and CMS reported blocking more than $4 billion in pending fraudulent Medicare payments.
Operation Gold Rush: $10.6B Transnational Scam Busted
A significant portion of the losses stemmed from Operation Gold Rush, which uncovered a sophisticated international Medicare fraud ring that submitted $10.6 billion in fraudulent claims using stolen medical identities. The DOJ credited data analytics teams with intercepting most of the payments, though $900 million still flowed to the criminals. Law enforcement has recovered $27.7 million to date.
AI-Generated Medicare Fraud and Global Ties
In Illinois, a $703 million scheme allegedly used AI-generated voice recordings to fake consent from Medicare patients and submit unauthorized claims. Authorities also charged a UAE-based executive with billing Arizona Medicaid $650 million for addiction treatment services that were either unprovided or dangerously substandard, often targeting Native American and homeless communities.
Wound Care, Kickbacks, and Opioids
Another set of indictments targeted doctors in Arizona and Nevada accused of $1.1 billion in fraudulent billing for unnecessary wound treatments. In Texas, prosecutors charged five individuals for illegally distributing over 3 million opioid pills through a pharmacy acting as a front for street-level drug networks.
Telemedicine Schemes and Fake COVID Testing
In South Florida, an executive was charged in a $46 million fraud operation involving deceptive telemarketing and phony Medicare claims for telemedicine and genetic testing. Prosecutors said the scheme preyed on seniors and exploited COVID-19 testing loopholes.
Fusion Center to Power AI-Driven Fraud Detection
The DOJ also announced the launch of a Health Care Fraud Data Fusion Center to integrate analytics across agencies using artificial intelligence and cloud computing. The center will implement Executive Order 14243, targeting data silos and expediting the identification of emerging fraud trends.
National Impact and Continued Prosecution
The DOJ’s Health Care Fraud Unit has now charged more than 5,400 defendants since the inception of its Strike Force in 2007. This year’s takedown more than doubles the previous record of $6 billion set in 2020. Investigations continue in partnership with the FBI, HHS, DEA, and 50+ other agencies.