The Justice Department today announced the 2026 National Health Care Fraud Takedown, which resulted in charges against 455 defendants, including 90 doctors and other licensed medical professionals, for their alleged participation in health care fraud and opioid abuse schemes involving over $6.5 billion in false claims and significant patient harm, including death. Today’s Takedown represents a new era in federal, state, and international cooperation to combat health care fraud: cases in 56 federal districts and 45 U.S. states and territories, with 50 state Medicaid Fraud Control Units participating, the most in Department history. In addition, unprecedented international cooperation over the two-week Takedown resulted in the apprehension and return to the United States of the following health care fraudsters: one defendant in Kyrenia in connection with an over $3.7 billion scheme; two defendants in Estonia in connection with a previously charged $10.6 billion scheme; and, in the Philippines, one of FBI’s Most Wanted Fraudsters in connection with a previously-charged $1.2 billion telemedicine fraud scheme. The Takedown involves the cutting-edge use of data analytics to target the worst actors; the seizure of over $182 million in cash, luxury vehicles, jewelry, and other assets; and full-spectrum accountability for all criminal actors from doctor’s offices to corporate boardrooms.
Today’s coordinated enforcement action involves a whole-of-government approach, including:
- Actions by the Centers for Medicare and Medicaid Services (CMS) to suspend 1,079 providers and revoke billing privileges for 1,403 providers.
- 48 Civil Monetary Payment settlements amounting to over $73 million, over 1,400 provider exclusions, and 25 actions by the U.S. Department of Health and Human Services, Office of Inspector General (“HHS-OIG”) under the Civil Monetary Penalties Law seeking more than $10 billion in payments to the Medicare Trust Fund from payments that CMS caught and suspended before the funds were paid to the fraudulent providers.
- Civil charges against 13 defendants for $14.8 million in health care fraud schemes, as well as civil settlements with 31 defendants totaling $23 million.
- 928 administrative cases by the Drug Enforcement Administration (DEA) seeking the revocation of authority to handle and/or prescribe controlled substances since October 1, 2025.
“This year’s National Health Care Fraud Takedown represents the greatest whole-of-government effort to combat health care fraud in our Nation’s history,” said Acting Attorney General Todd Blanche. “Under the decisive leadership of President Donald Trump, Vice President JD Vance, the White House Task Force to Eliminate Fraud, and our law enforcement partners, this administration has ushered in a new era of enforcement that will safeguard taxpayer dollars.”
“We are aggressively scaling our offensive against anyone using health care as a front to steal from the American people,” said Assistant Attorney General Colin M. McDonald of the Justice Department’s National Fraud Enforcement Division. “As today’s cases and arrests show, there is no case too big, no scheme too complex, and no hiding place too remote for our relentless fraud-fighting team. Our message is simple: if you put profit over patients, you should expect to be put in prison.”
“Health care fraud steals from taxpayers, exploits vulnerable patients, and puts lives at risk,” said U.S. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. “Today’s historic enforcement action sends a clear message: if you use our health care system to enrich yourself at the expense of patients or the American people, we will find you, we will prosecute you, and we will hold you accountable. HHS will continue working with our law enforcement partners to protect patients, safeguard taxpayer dollars, and restore integrity to our health care system.”
“The coordination in the Health Care Fraud Takedown reinforces the Trump Administration’s efforts to end the crimes of bad actors who have ripped off U.S. taxpayers,” said Department of Homeland Security Secretary Markwayne Mullin. “This is a whole of government effort, to hold those who defraud our nation accountable. Our message is clear: if you steal from American taxpayers, you will face the consequences.”
“This results of this nationwide healthcare takedown are historic,” said FBI Director Kash Patel. “Under the leadership of President Trump, Vice President Vance, and the White House Task Force to Eliminate Fraud, this FBI worked alongside our DOJ partners to arrest and charge over 450 people, including almost 100 medical professionals, for over $6 billion in alleged healthcare fraud schemes – showing the enormous amount of work done by our interagency law enforcement team over the last month and beyond. While today’s announcement is one of the largest on record-every arrest is a continued message to criminal actors who rob American taxpayers that you will not get away with your crimes.”
Fraudulent Wound Care Schemes
Charges were filed against 11 defendants, including a company executive and eight medical professionals, across six districts in connection with billions of dollars in fraudulent claims for amniotic wound allografts. In the District of Arizona, the Vice President of Sales for a company that sold allografts was charged in a nationwide illegal kickback and health care fraud scheme. From approximately December 2021 through June 2024, providers billed Medicare over $4 billion for this company’s allografts, resulting in over $2 billion in payments. This significant spike in allograft billings was alleged to have been driven not by medical necessity, but by a kickback scheme that generated substantial profit margins and lavish lifestyles for marketers and providers who participated. The company did not manufacture allografts and instead acquired allografts from tissue banks and relabeled them for sale at a 2,000% mark-up, charging up to $1,450 per square centimeter. The defendant is alleged to have paid illegal kickbacks of approximately 40% of that amount, allowing marketers and medical providers to pocket approximately $500-600 per square centimeter. These lucrative kickbacks allegedly caused the defendant and others to target hospice patients and apply the allografts 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. The defendant received over $24 million from the company, which he used to purchase multi-million-dollar houses, million-dollar life insurance policies, luxury vehicles, including a $135,000 Maserati, and luxury watches. This follows 15.5- and 14-year sentences obtained last year in connection with the scheme .
Today’s charges reflect the Department’s intention to prosecute both the architects of fraud and those who betray their oath to carry out the scheme. In the Southern District of Texas, a nurse practitioner was charged for a $906 million scheme in which she applied medically unnecessary allografts and billed Medicare more than $1 million per patient on average. As alleged, the defendant used the fraud proceeds to purchase high-end vehicles, real estate, and luxury jewelry, and to fund the construction of a $4.6 million of a beach resort in the Philippines. The government seized over $30 million in bank accounts, a $594,000 Ferrari 296 GTS, seven other high-end vehicles, an $865,000 custom Bulgari necklace, and $1 million worth of other luxury jewelry.
$865,000 Bulgari necklace seized as proceeds of alleged Medicare fraud scheme involving wound allografts; rendering of beach resort in the Philippines constructed with $4.6 million allegedly stolen from Medicare in wound allograft fraud scheme
Similarly, in the Middle District of Florida, three defendants were charged for their roles in an $118 million allograft fraud scheme where a nurse practitioner allegedly used the proceeds to fund her lavish lifestyle, including a luxury box at an NFL stadium and over $400,000 in fine art.
The Health Care Fraud Unit’s Data Analytics Team detected a spike in payment for allografts, leading to prosecutions. CMS separately realigned payment, reducing Medicare’s payment to $127 per square centimeter starting on January 1, 2026. If CMS had not taken action to address unprecedented spending on allografts, the Part B premium increase caused by allograft payments alone would have cost every Medicare beneficiary in the country an extra $11 a month.
“Prosecuting criminals who steal from American patients is necessary-but stopping them before a single dollar leaves the building is smarter,” said CMS Administrator Dr. Mehmet Oz. “CMS is done playing catch-up. We’re deploying advanced data analytics to expose fraud networks, freeze suspicious payments, and shut down bad actors before they can do damage to the programs that millions of Americans depend on.”
Data Fusion Center, Financial Intelligence Review Team, and Data Analytics Enhancements
The Health Care Fraud Unit is a leader in employing advanced data analytics. Its Data Fusion Center -announced as part of last year’s Takedown and comprised of experts from the Unit’s Data Analytics Team, HHS-OIG, FBI, and other agencies-used advanced analytics in many of the cases charged today. The Department is announcing the first prosecution arising from the Fusion Center’s Financial Intelligence Review Team, which was formed last year to combine traditional data analytics with financial analysis, in connection with a $67 million scheme to bill Illinois Medicaid for behavioral health services that were not provided. The defendant allegedly submitted claims to Medicaid for 500 or more hours of counseling and therapy services per day, well in excess of what the providers on staff could render even if all providers were working 24 hours per day, and diverted over $27 million to brokerage accounts, $10 million to a luxury car dealership he set up, $4 million for real estate purchases and home improvements, one million for jewelry, watches, purchases, and other luxury items, and over $616,022 for vehicles. Data analysis established that patients were hospitalized at other institutions on days that the defendant billed for behavioral health services, and the Health Care Fraud Unit’s specialized prosecutors opened the investigation within five days of the financial intelligence review. The defendant was arrested less than seven months later at the airport Sunday night attempting to leave the country.
Yacht and Bentley Continental GT purchased with proceeds of alleged fraud
In the Central District of California, charges were brought against a hospice owner and two marketers for a $27.7 million Medicare fraud scheme in which the hospice owner allegedly tried to avoid detection through a scheme to purchase information of the recently deceased from a funeral home employee. The defendant was allegedly carrying out a hospice fraud scheme in which he fraudulently enrolled patients who were not terminally ill. Concerned that Medicare and law enforcement used data analytics to monitor the percentage of patients discharged from hospice alive (an indicator of fraud), the hospice owner allegedly paid illegal kickbacks of $1,000 to $3,000 per person to a funeral home employee in exchange for deceased Medicare beneficiaries’ information. The defendant then allegedly billed Medicare for a few days of hospice services for these recently-deceased individuals who hadn’t received hospice care and created fake, back-dated medical records claiming that the beneficiaries had been seen by a physician, thereby allegedly seeking to deceive Medicare by reducing his outlier data metrics.
In today’s Takedown, the Department announced the seizure of over $27 million in fraudulent Medicare payments in the Southern District of Florida as part of a data-driven effort to target “bust-out schemes” involving 12 clinics that billed Medicare millions of dollars for allografts that were never provided to patients. This novel and proactive “follow and seize the money” approach maximized recovery of stolen taxpayer dollars.
To enhance the deployment of advanced analytics to target health care fraud, the Fraud Division and CMS announced today that they have entered an agreement whereby the Fraud Division will be provided cloud computing space in the CMS Integrated Data Repository environment in which to deploy advanced data analytics algorithms and artificial intelligence tools. In addition, the Fraud Division entered into agreements with the Department of Homeland Security and the Federal Trade Commission aimed at breaking down data silos and improving access to information critical to identifying and combatting health care fraud. CMS also is announcing today that it is developing a Claims Core processing with electronic attestation, identify verification, and IP address log-in, and working to get pledges that all Medicaid, Managed Care, and other plans report the same standardized data fields used for Medicare Part B claims data.
Patient Harm
“Safeguarding the integrity of federal health care programs is central to our mission, and the results of this year’s National Health Care Fraud Takedown reflect the strength of our collective commitment. The cases announced today demonstrate not only the scale, but the seriousness of the misconduct uncovered, ranging from patient harming schemes to multibillion dollar fraud operations,” said HHS Inspector General T. March Bell. “HHS-OIG will continue to pursue those who engage in such conduct and hold them accountable. I am grateful for the tireless work of our special agents and for the partnership we share with our federal, state, and local law enforcement colleagues as we work together to protect patients and preserve public funds.”
In Alaska, state prosecutors charged a defendant for medical assistance fraud based on allegations that, while working as a personal care attendant for a Medicaid recipient, the defendant submitted false claims for regularly attending to the recipient’s health and hygiene, at the same time that she was admitted to the hospital for suffering from severe neglect, including being soiled in urine.
Medicaid Fraud
Data shows that Medicaid is a vital government benefit program increasingly targeted by criminals. Building upon the success of the recent Minnesota Health Care Fraud Takedown and the Acting Attorney General’s authorization of an enhancement for the Health Care Fraud Unit to investigate Medicaid fraud nationwide, today’s Takedown includes the largest number of Medicaid fraud defendants and Medicaid fraud loss charged in Department history: 295 defendants and over $518 million in false claims submitted to Medicaid.
In the Eastern District of New York, charges were brought against eight defendants for their role in a $38 million fraud on New York Medicaid for social adult day care services that were medically unnecessary, procured by kickbacks to marketers and beneficiaries, and never provided. Although the permitted occupancy of the social adult day cares (shown below) was only 30 people, the defendants fraudulently submitted claims for services provided to hundreds of beneficiaries per day.