Historic National Health Care Fraud Takedown Nets 324 Defendants in $14.6 Billion Fraud Scheme

In a landmark operation, the U.S. Department of Justice (DOJ) announced the 2025 National Health Care Fraud Takedown, the largest of its kind in history, charging 324 defendants across 50 federal districts and 12 state jurisdictions with fraud schemes totaling over $14.6 billion in intended losses. This unprecedented effort, which more than doubles the previous record of $6 billion, targets a wide range of health care fraud schemes that exploit vulnerable patients and siphon taxpayer dollars from critical programs like Medicare and Medicaid. Among the notable regional efforts, the Southern District of Texas (SDTX) contributed significantly, charging nearly 50 individuals as part of this national crackdown. “Combined efforts have resulted in charges against 18 medical professionals after nearly 12 million pills distributed and over $360 million fraudulently billed to Medicare,” according to a recent SDTX press release.

A Coordinated Crackdown on Fraud

The Takedown, led by the DOJ’s Health Care Fraud Unit in collaboration with federal and state law enforcement agencies, including the FBI, DEA, and HHS Office of Inspector General (HHS-OIG), represents a whole-of-government approach to combatting health care fraud. The operation resulted in the seizure of over $245 million in assets, including cash, luxury vehicles, and cryptocurrency, underscoring the significant financial impact of these enforcement efforts. Additionally, the Centers for Medicare and Medicaid Services (CMS) prevented over $4 billion in fraudulent claims and suspended or revoked the billing privileges of 205 providers in the lead-up to the Takedown.

“This record-setting health care fraud takedown delivers justice to criminal actors who prey upon our most vulnerable citizens and steal from hardworking American taxpayers,” said Attorney General Pamela Bondi. “Make no mistake – this administration will not tolerate criminals who line their pockets with taxpayer dollars while endangering the health and safety of our communities.” The SDTX effort echoes this sentiment, with U.S. Attorney Nicholas J. Ganjei stating, “Americans rely on Medicare for needed treatments and living-saving care. Those that bilk this fund to unlawfully enrich themselves are ultimately stealing from the taxpayer and damaging public confidence in our health care system… Today’s takedown is a reminder to would-be medical fraudsters that the Department of Justice is always standing guard over the public fisc.”

Transnational Criminal Organizations Targeted

A significant portion of the Takedown focused on transnational criminal organizations, with 29 defendants charged for submitting over $12 billion in fraudulent claims. One notable case, dubbed Operation Gold Rush, marked the largest single health care fraud case ever brought by the DOJ. This nationwide scheme involved 19 defendants who allegedly used foreign straw owners to purchase medical supply companies across the U.S. These entities submitted $10.6 billion in fraudulent Medicare claims for items like urinary catheters, exploiting the stolen identities of over one million Americans.

Fraudulent Wound Care and Opioid Trafficking

The Takedown also addressed fraudulent wound care schemes, with seven defendants, including five medical professionals, charged in Arizona and Nevada for $1.1 billion in fraudulent Medicare claims involving unnecessary amniotic wound allografts. In the realm of opioid trafficking, 74 defendants, including 44 licensed medical professionals, faced charges for illegally diverting over 15 million prescription opioid pills. The SDTX cases align with this focus, targeting schemes involving the unlawful distribution of controlled substances, some of which were diverted onto the black market, as noted in the local press release.

Telemedicine and Genetic Testing Fraud

Telemedicine and genetic testing fraud schemes accounted for $1.17 billion in fraudulent claims, with 49 defendants charged. In the Southern District of Florida, an owner of telemedicine and durable medical equipment companies was accused of a $46 million scheme targeting Medicare beneficiaries through deceptive telemarketing.

Other Fraud Schemes

An additional 170 defendants were charged with $1.84 billion in fraudulent claims involving unnecessary diagnostic tests, medical visits, and treatments. A standout case from the SDTX involves one of the largest local schemes, where three individuals were charged for their alleged roles in a $10 million hospice fraud and kickback scheme. “The charges allege Dera Ogudo, 39, and Victoria Martinez, 35, both of Richmond, operated hospice company United Palliative & Hospice Company (UPHC) that misled vulnerable elderly adults about what services were being billed to their Medicare and Medicaid plans. According to court documents, UPHC Medicare and Medicaid beneficiaries and/or their family members believed they would be receiving palliative or home health services. In truth, these patients were enrolled in hospice services but were not actually terminally ill as Medicare and Medicaid requires, according to the charges. Ogudo allegedly paid kickbacks to several group homeowners in exchange for enrolling their beneficiaries in hospice with UPHC and bribed a physician to certify and re-certify UPHC patients as terminally ill when they were not. Ogudo also allegedly paid kickbacks to Evelyn Shaw, 52, Houston, in exchange for enrolling her patients in hospice with UPHC,” the SDTX press release detailed.

A Data-Driven Approach to Combat Fraud

The Takedown’s success was bolstered by advanced data analytics and interagency collaboration. The DOJ announced the creation of a Health Care Fraud Data Fusion Center, uniting experts from the DOJ, HHS-OIG, FBI, and other agencies to leverage AI and cloud computing for real-time fraud detection.

“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,” said CMS Administrator Dr. Mehmet Oz. “We’re not waiting for fraud to happen—we’re stopping it before it starts.”

A Commitment to Protecting Vulnerable Americans

The 2025 Takedown underscores the DOJ’s commitment to safeguarding critical health care programs and protecting vulnerable populations, including the elderly, disabled veterans, and those struggling with addiction. The operation’s scale and impact highlight the devastating consequences of health care fraud, which not only drains public resources but also endangers patient safety through unnecessary treatments and substandard care.

As FBI Director Kash Patel noted, “Health care fraud drains critical resources from programs intended to help people who truly need medical care.” The collaborative efforts of federal and state agencies, supported by cutting-edge technology, signal a robust and ongoing fight to hold fraudsters accountable and preserve the integrity of America’s health care system.