$14.6 Billion in Healthcare Fraud Busted in Takedown

The U.S. Department of Justice in joint efforts with the Department of Health and Human Services and other federal and state agencies said it has busted a record-breaking $14.6 billion in a wide range of healthcare fraud incidents in 2025.

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The federal government also plans to ramp up those collaborative nationwide healthcare fraud investigations through a new “fusion center” involving multiple agencies, artificial intelligence, cloud and other technologies, the Department of Justice said.

The 2025 National HealthCare Fraud Takedown – which more than doubled DOJ’s previous $6 billion record – resulted in criminal charges against 324 defendants, including 96 doctors, nurse practitioners, pharmacists and other licensed medical professionals, in 50 federal districts and 12 state attorneys general offices across the country.

The busts included a wide variety of billing and related schemes, including scams amounting to more than $12 billion in fraudulent claims. That includes fake claims related to wound care, durable medical equipment, telemedicine, COVID and genetic testing services, substance abuse treatments and many other services submitted to Medicare, Medicaid and other government programs.

Authorities filed criminal HIPAA violation charges related to the unlawful use and disclosure of patients’ protected health information in the submission of fake claims in at least one case – an alleged $894 million COVID-19 testing scheme that led to the indictment of a physician, Dr. Anosh Ahmed, and several co-conspirators. The DOJ said they were indicted for their roles in an $894 million fraudulent COVID-19 testing scheme involving $293 million in claims payouts.

Fusion Center

To boost the coordinated nationwide investigations, the Department of Justice said it is working closely with the FBI, the HHS Office of Inspector General and other agencies to create a new Healthcare Fraud Data Fusion Center.

The fusion center will use cloud computing, artificial intelligence and advanced analytics to identify emerging healthcare fraud schemes. It will build upon a healthcare fraud unit data analytics team launched in 2018 enhance the federal government’s ability to detect, investigate and prosecute complex healthcare fraud schemes, the department said.

The ramped-up investigations also comply with President Donald Trump’s executive order – Stopping Waste, Fraud and Abuse by Eliminating Information Silos – that calls for reducing “duplicative data teams, increasing operational efficiency through a whole-of-government approach and leveraging cloud computing, artificial intelligence and other agency resources,” the department said.

“Healthcare fraud has long been a priority of the DOJ, HHS-OIG and the FBI,” said regulatory attorney Rachel Rose, who is not involved in the current takedown cases. “I do believe that we will see larger takedowns that are both initiated by the government and whistleblowers because of the harm to taxpayers and the return of funds to the federal fisc,” she said. This work expands on the 2009 creation of the Health Care Fraud Prevention and Enforcement Action Team – or HEAT Task Force, she said.

In fact, for more than a decade, the DOJ-HHS joint healthcare fraud takedown efforts have sought to break previous years’ efforts (see: 243 Charged in Medicare Fraud Schemes).

The new fusion center through the use of improved inter-agency collaboration, AI and other technologies could potentially boost those effort even further, Rose said. “If the data is accurate, then the potential to detect and analyze significant amounts of data is advantageous from time and efficiency vantage points,” she said.

“In turn, since there is a coordinated effort between agencies, enforcement actions can be deployed more quickly,” she said. “From a False Claims Act standpoint, the government can verify the data and even if it declines to prosecute the case and gives the relator the option of doing so, outliers, like those identified in the roundup are at increased risk of large settlements and/or jury verdicts,” she said.

Also, as long as AI is deployed in a safe, ethical and legal manner, there are significant upsides, she said. “The government does not need to go outside its own data, including Medicare and Medicaid claims, to gain the efficiencies of closed AI systems. Because AI can analyze large amounts of data rapidly and subsequent analyses can be done from a statistical standpoint including varying types of regression analyses, it helps with time management and damage models.”