DOJ boasts record-breaking $14.6B health fraud "takedown"
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CMS administrator Mehmet Oz speaks during a press conference on the health care fraud enforcement. Photo: Mandel Ngan/AFP via Getty Images
Federal officials on Monday said that they busted a series of health fraud schemes spanning medical supply, telehealth and genetic testing companies, as well as opioid trafficking, that involved more than $14.6 billion in improper charges.
Why it matters: As part of the record-breaking operation, the Centers for Medicare & Medicaid Services announced it also prevented $4 billion in fraudulent claims from being paid.
Zoom in: Officials seized over $245 million in cash, luxury vehicles, cryptocurrency and other assets as part of the "takedown."
- The alleged fraud took place across 50 federal districts across the U.S. and resulted in criminal charges against 324 individuals, including nearly 100 health providers. Indictments were unsealed in federal courts across the country last week.
- Civil charges were also brought against 20 defendants for $14.2 million in alleged fraud, as well as civil settlements with 106 defendants totaling $34.3 million.
Between the lines: The activity included Operation Gold Rush, a nationwide investigation begun in 2023 that encompassed the largest loss ever recorded in a health fraud case, officials said.
- A transnational organization used a network of foreign straw owners who bought medical supply companies and quickly submitted $10.6 billion in fraudulent health care claims to Medicare for urinary catheters and other durable medical equipment using stolen identities of more than 1 million Americans.
- They allegedly laundered the proceeds and transferred funds into cryptocurrency and shell companies abroad.
- Officials say they prevented the organization from receiving all but approximately $41 million of the roughly $4.45 billion due to be paid by Medicare. Nineteen people were charged and 12 arrested, including four who were apprehended in Estonia.
The operation was led by the Justice Department's Health Care Fraud Unit, as well as U.S. attorneys, the HHS inspector general, the FBI and the Drug Enforcement Administration.
What they're saying: "Today's unprecedented enforcement action demonstrates that CMS and our federal partners are united in our mission to protect the integrity of Medicare and Medicaid by crushing waste, fraud, and abuse," CMS administrator Mehmet Oz said in a statement.
