Federal Government Takes Down Health Care Fraud Totaling Over $14.6 billion
On June 30th, 2025, the US Department of Justice's Office of Public Affairs announced the 2025 Health Care Fraud Takedown. Health care fraud schemes totaled $14.6 billion dollars in intended loss, making it the largest health care fraud takedown in history, more than doubling the previous record of $6 billion. 324 defendants received charges of health care fraud, including 96 licensed medical professionals. $245 million in cash, luxury vehicles, and cryptocurrency were seized by the government, showing the extent of the value of property allegedly connected to fraud.
About the 2025 Health Care Fraud Takedown
According to the DOJ, in the 2025 National Health Care Fraud Takedown, one of the most alarming trends was the rise of transnational fraud operations. The operation accuses international criminal networks, often based in Eastern Europe, the Middle East, and Asia, of acquiring control of U.S based medical supply companies using shell corporations. Once established, they allegedly used stolen identities of real patients and doctors to submit fake claims to Medicare for high-cost items like urinary catheters and durable medical equipment. One single fraud network was said to have been responsible for over $10 billion in fraudulent claims.
These schemes were not only large-scale but also highly sophisticated, allegedly involving complex money laundering tactics, including converting Medicare funds into cryptocurrency or investing in luxury goods like yachts, real estate, and vehicles. Per the DOJ’s report, The criminal groups used overseas actors to obscure ownership and evade detection, exploiting regulatory gaps between U.S. and foreign jurisdictions.
A key component within the alleged scams are Medicaid and Medicare Fraud, which take advantage of vulnerable patients who should be receiving their healthcare from these government programs. These types of schemes are especially dangerous, because they involve identity theft of patients in need of critical health care, which can prevent them from receiving the medical treatment they need. Along with this, elderly and vulnerable patients can also receive medically unnecessary treatments, or incorrect treatments in the process, worsening their health.
Licensed medical professionals also utilized these scams to receive unnecessary amounts of opioids and other controlled substances for the purpose of reselling them to street level drug dealers. This contributes to the growing nation-wide opioid epidemic and has the potential to lead to higher amounts of opioid related abuse and overdoses. Because of the disastrous effects of these fraudulent health care schemes, they have the potential to be some of the more dangerous types of Financial Crimes. The DOJ investigates and prosecutes these cases especially heavily, to try and prevent more of this fraud from occurring as soon as it is identified.
How the DOJ Investigates and Prosecutes Healthcare Fraud
The Department of Justice works in partnership with the Federal Bureau of Investigation (FBI), HHS-OIG, DEA, and other federal and state agencies to investigate health care fraud. The cases in the 2025 takedown were uncovered using advanced data analytics, artificial intelligence, and billing pattern analysis. The Health Care Fraud Data Fusion Center played a critical role by flagging anomalies in billing data across providers nationwide, allowing law enforcement to trace fraudulent claims back to their source.
Once targets are identified, the DOJ coordinates a multi-agency enforcement action, often freezing assets and suspending Medicare billing privileges before indictments are announced. In the 2025 takedown, federal prosecutors filed charges against 324 defendants across 50 judicial districts. The DOJ also worked with CMS to recover approximately $4 billion in fraudulent payments and suspend over 200 providers from participation in federal health care programs.
How the 2025 Health Care Fraud Takedown differs from More Common Healthcare Fraud
Traditional health care fraud cases typically involve small-scale actors, such as individual clinics or practitioners submitting inflated claims or billing for services not rendered. These cases, while serious, tend to involve thousands or millions of dollars and are often limited to a local or state level. In contrast, the 2025 takedown focused on transnational networks, operating globally, resulting in federal charges with potentially far more severe consequences.
Another key difference is the level of organization and sophistication. These weren’t isolated incidents of overbilling but were reported by the DOJ to have been coordinated operations using global financial systems, stolen patient data, and dummy corporations. The involvement of foreign actors, the use of cryptocurrency, and the targeting of Medicare with high-volume claims set these schemes apart from the more routine fraud cases seen in previous years. This reflects the DOJ’s evolving focus on dismantling large-scale fraud rings that pose systemic risks to public health and federal benefit programs.
Possible Defenses to Healthcare Fraud
Because of the severity of the offenses, anyone who was charged in the 2025 Health Care Fraud Takedown is facing years in prison, as well as hefty fines. However, there are a few defenses that could be argued in court of law to clear their names.
- Lack of Knowledge or Intent - Many individuals charged, especially lower-level employees or contractors, may argue they did not know they were participating in a fraudulent scheme. Since most health care fraud crimes require intentional misconduct, a defendant could argue they were simply following orders, unaware that billing practices or supply orders were illegal.
- Good Faith Reliance on Business Practices - Several defendants may argue that they relied in good faith on routine business operations, third-party vendors, or billing software. If a foreign shell company acquired a U.S medical supply business and continued billing practices that appeared consistent with past operations, a manager or executive might argue they lacked reason to suspect wrongdoing. This defense is particularly relevant to professionals accused of aiding schemes without active participation in their design.
- Insufficient Evidence or Improper Identification - In cases involving stolen identities, some defendants may claim they were misidentified, that their name or license was used fraudulently without their knowledge. For example, a doctor whose National Provider Identifier was used in fraudulent claims might not have been involved in any scheme and could argue that they were a victim, not a perpetrator. Other defendants might argue that the government has insufficient direct evidence tying them to the fraudulent activity, especially in sprawling multinational cases.
- Procedural Defenses- Some defendants may challenge the legality of the investigation itself. If law enforcement seized emails, financial records, or property without proper warrants or outside the authorized scope, a motion to suppress evidence may be filed. If key evidence is excluded, the government’s case could be significantly weakened.
- Entrapment or Government Overreach - In rare cases, especially if the government used undercover agents or informants, defendants may assert entrapment, claiming they were induced to participate in fraudulent acts they would not have committed otherwise. This defense would require showing that the idea and encouragement to commit fraud came primarily from law enforcement.
- Withdrawal from the Scheme or Voluntary Disclosure - Some defendants may assert that they withdrew from the fraud before the charges were filed and took steps to alert authorities or correct their conduct. If a participant stopped cooperating with a fraudulent entity and later reported suspicious activity, this could serve as a mitigating factor or full defense in some jurisdictions.
Despite the severity of these cases, it is important to remember the expectation that all defendants charged are innocent until proven guilty in a court of law. It is especially important to keep this idea in mind in financial crimes that involve stolen identities. There could very well be cases of misidentification of suspects, or other extraneous factors which led to innocent people unknowingly being wrapped up in this transnational Health Care Fraud Scheme.
Additional Resources
2025 National Health Care Fraud Takedown – This article is the official press release from the DOJ’s Office of Public Affairs. This discusses the massive takedown of Health Care Fraud in 2025, totaling over 14 billion dollars.
Health Care Fraud Unit of the DOJ – Visit the DOJ’s health care fraud unit website, to learn more about how health care fraud crimes are investigated and prosecuted
Hire a Health Care Fraud Defense Attorney In Iowa or for Federal Charges
If you or a loved one has been charged with a Federal or State level Health Care Fraud offense in Iowa, it is important to hire a criminal defense attorney immediately. McCarthy and Hamrock, P.C, can provide the legal assistance you need to ensure your case is in the right hands, and you will be getting the best representation that you deserve.
Call (515-279-9700) to request a free consultation.
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