Nearly every summer, the U.S. Department of Justice (DOJ) announces a large-scale healthcare fraud “takedown.” The DOJ announced its latest such action on June 30, 2025. In its press release, the DOJ announced that it had charged 324 defendants in connection with over $14.6 billion in alleged fraud. The defendants included 96 doctors, nurse practitioners, pharmacists, and other licensed medical professionals. In bringing these actions, the DOJ worked with various federal and state law enforcement agencies, including 12 State Attorneys General’s Offices across the country. According to the DOJ’s press release, “[t]he [t]akedown involved federal and state law enforcement agencies across the country and represents an unprecedented effort to combat health care fraud schemes that exploit patients and taxpayers.” The takedown was lead by the DOJ’s Criminal Health Care Fraud Unit, and also involved the Department of Health & Human Services, Office of Inspector General (HHS-OIG), the FBI, and the DEA.
The DOJ also announced that, in addition to the criminal charges, it seized over $245 million in allegedly ill-gotten assets, including cash, luxury vehicles, and cryptocurrency. Additionally, the Centers for Medicare and Medicaid Services (CMS) announced that it prevented over $4 billion from being paid in response to “false or fraudulent claims” and that it had suspended or revoked the billing privileges of 205 providers in the months leading up to the takedown. Finally, the government announced the filing of civil actions against 20 defendants alleging a total of over $14 million in fraud, as well as civil settlements with an additional 106 defendants, totaling $34.3 million in alleged fraud.
Included among the criminal charges were:
- Transnational Criminal Organizations: Twenty-nine defendants were charged for their roles in “transnational criminal organizations alleged to have submitted over $12 billion in fraudulent claims to America’s health insurance programs.”
- Fraudulent Wound Care: Seven defendants, including five medical professionals, were charged with schemes involving allegedly fraudulent wound care. Specifically, the DOJ alleged that these defendants applied medically unnecessary amniotic allografts to the wounds of certain vulnerable patients, often times without coordination with the patients’ treating physicians, without proper treatment for infection, to superficial wounds that did not need this treatment, and to areas that far exceeded the size of the wound. In addition, the DOJ alleges that certain defendants allegedly received millions in illegal kickbacks from the fraudulent billing scheme.
- Opioid Trafficking and Diversion: Seventy-four defendants, including forty-four licensed medical professionals, were charged with the alleged illegal diversion of over 15 million pills of prescription opioids and other controlled substances.
- Telemedicine and Genetic Testing Fraud: Forty-nine defendants were charged in connection with the submission of over $1.17 billion in allegedly fraudulent claims to Medicare resulting from telemedicine and genetic testing fraud schemes. In one such case, the DOJ charged an owner of telemedicine and durable medical equipment (DME) companies with a $46 million scheme in which Medicare beneficiaries were allegedly targeted through deceptive telemarketing campaigns and then fraudulent claims were submitted to Medicare for DME and genetic tests for these beneficiaries.
- Pharmacy Fraud: Three defendants, including business owners and a pharmacist, were charged by federal prosecutors in Tennessee with a $28.7 million scheme to defraud the Federal Employees’ Compensation Fund by allegedly billing for medications for injured Postal Service employees that were never prescribed by a licensed practitioner and largely were not dispensed as claimed.
Creation of Health Care Fraud Data Fusion Center
In connection with the takedown, the DOJ also announced the creation of the Health Care Fraud Data Fusion Center. As part of the Center, the DOJ is working with various federal agencies including HHS-OIG, FBI, and others “to leverage cloud computing, artificial intelligence, and advanced analytics to identify emerging health care fraud schemes.” According to the DOJ’s press release, the DOJ’s Criminal Health Care Fraud Unit (which was established in 2018) will be joining forces with data analysts from HHS-OIG, FBI, and other partners to “increase efficiency, detection, and rapid prosecution of emerging health care fraud schemes.”
The Center will also work to implement President Trump’s Executive Order No. 14243, which was issued on March 20, 2025, and entitled “Stopping Waste, Fraud, and Abuse by Eliminating Information Silos.” The Center will implement the President’s EO by “reducing duplicative data teams, increasing operational efficiency through a whole-of-government approach, and leveraging cloud computing, artificial intelligence, and other agency resources.”
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The attorney at Chilivis Grubman represent healthcare providers of all types and sizes in connection with criminal, civil, and administrative enforcement actions, as well as government investigations including those conducted pursuant to the federal False Claims Act. If you need assistance with such a matter, contact us today.