In what the federal government called the “largest Justice Department healthcare fraud takedown in history,” 324 individuals — including 96 medical providers — have been arrested in connection with schemes that amount to $14.6 billion in fraud, according to a June 30 news release from the department.
The investigations span billing fraud, kickbacks, opioid diversion, genetic testing scams and other schemes, according to the release.
The Justice Department also seized $245 million in cash, luxury goods, cryptocurrency and other assets. CMS prevented $4 billion in false payments and suspended or revoked 205 providers’ billing privileges, and civil charges included cases involving $14.2 million in alleged fraud and $34.3 million in settlements, the release said.
Here is a breakdown of the alleged schemes, as detailed by the Justice Department:
Transactional fraud: More than $12 billion
- Operation Gold Rush, a nationwide investigation, involved $10.6 billion in false Medicare claims using stolen identities of more than 1 million Americans.
- Defendants used foreign straw owners, encrypted messaging and laundered money through cryptocurrency and shell companies.
- According to the release, $4.41 billion in payments were blocked, but $900 million was paid out.
- Other cases included a $703 million AI-enabled scam using fake beneficiary consents and a $650 million Arizona Medicaid scheme that exploited vulnerable populations with substandard addiction care.
Wound care fraud: $1.1 billion
- Medical professionals applied unnecessary amniotic allografts to elderly and hospice patients.
- Defendants received millions in kickbacks.
Opioid trafficking
- In a scheme involving 15 million pills, 74 defendants — including 44 licensed providers — were charged across 58 cases.
Telemedicing and genetic testing fraud: $1.17 billion
- Forty-nine individuals were charged in schemes involving fraudulent billing for telehealth services, genetic tests and durable medical equipment.
At the Becker's 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, taking place June 11-13 in Chicago, spine surgeons, orthopedic leaders and ASC executives will come together to explore minimally invasive techniques, ASC growth strategies and innovations shaping the future of outpatient spine care. Apply for complimentary registration now.
