DOJ Health Care Fraud Takedown Reveals $6.5 Billion In False Claims

The Department of Justice announced a major medical fraud bust on Tuesday which resulted in charges against 455 defendants for billions in alleged false claims.

“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,” the DOJ press release said.

Acting Attorney General Todd Blanche explained how medical fraud schemes billed government programs to net large payouts at the taxpayer’s expense.

Assistant Attorney General Colin M. McDonald said that “if you put profit over patients, you should expect to be put in prison.”

Department of Homeland Security Secretary Markwayne Mullin said that “if you steal from American taxpayers, you will face the consequences.”

“Health care fraud steals from taxpayers, exploits vulnerable patients, and puts lives at risk,” Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. said.

Multiple agencies were involved in the fraud takedown, according to the press release:

• 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.

New technological systems were deployed to identify the fraudulent behavior.

“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 press release said.