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The Department of Justice (DOJ) announced sweeping charges Monday against more than 300 defendants, alleging they misled patients into paying for, and sometimes receiving, medical care that they did not need.
In turn, DOJ Criminal Division chief Matthew Galeotti said, the defendants also attempted to swindle Medicare and other taxpayer-funded and private health insurance programs out of about $14.6 billion.
The announcement marked the “largest coordinated healthcare fraud takedown in the history of the Department of Justice,” Galeotti said during a press conference.
In a press release, the DOJ said 29 of the defendants were charged with alleged involvement with transnational criminal organizations and submitting over $12 billion in fraudulent claims to America’s health insurance programs.
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Another 74 defendants, including 44 licensed medical professionals, were charged across 58 cases with allegedly illegally distributing 15 million prescription pill opioids and other controlled substances. For instance, five of the defendants at a Texas pharmacy are accused of unlawfully distributing over 3 million opioid pills, including oxycodone, hydrocodone and carisoprodol, which were later trafficked by drug dealers on the streets.
The DOJ said 49 defendants were charged with submitting over $1.17 billion in alleged fraudulent claims to Medicare, while an additional 170 defendants were charged with various other fraudulent schemes amounting to $1.84 billion in claims to Medicare, Medicaid and private insurance companies for diagnostic testing, medical visits and unnecessary treatments, sometimes for kickbacks and bribes.
“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,” Attorney General Pamela Bondi said. “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.”
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One set of charges included, for example, an indictment against three defendants in Arizona who allegedly conspired to purchase and give elderly Medicare recipients skin grafts known as “amniotic wound allografts.” The defendants allegedly reaped millions of dollars from the practice.
One of the defendants, a nurse practitioner, applied the grafts to patients even though they were “medically unreasonable and unnecessary,” the indictment said. The nurse allegedly applied them to terminally ill patients in hospice, including some who were days away from dying.
While that specific medical practice is typically non-invasive, Galeotti noted it was part of a $1 billion healthcare fraud scheme that stripped patients of “dignity and peace” in their final days.
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“That conduct is exactly as callous and disturbing as it sounds,” Galeotti said. “Patients and their families trusted these providers with their lives. Instead of receiving care, they became victims of elaborate criminal schemes.”
One DOJ official said in response to a question from Fox News Digital that skin grafts were an “emerging area” of healthcare fraud, “especially given the significant amount of money that they can bill for sometimes in excess of $1,000 a square centimeter.”
The healthcare fraud cases, all of which were shared publicly online, spanned the country and globe. Defendants included medical supply company owners and medical professionals, including 25 doctors.
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An FBI official announced at the press conference that one scheme, called “Operation Gold Rush,” resulted in at least 20 members of a transnational criminal organization, including defendants based in Russia, being charged as part of a $10 billion Medicare and money laundering operation that centered on catheters.
The group behind the scheme, authorities said, used foreign straw owners to secretly buy dozens of medical supply companies before using stolen identities and confidential health data to create and file false $10.6 billion in claims with Medicare.
The DOJ said 19 defendants were arrested for their involvement in the scheme, 12 of whom have been arrested. Of the 12, four were apprehended in Estonia as a result of international cooperation with Estonian law enforcement. Seven of the defendants were arrested at U.S. airports and the U.S. border.
The DOJ Criminal Division’s healthcare fraud unit led the effort. Galeotti said Monday the DOJ also launched a “fusion center” in which it would join forces with other agencies to consolidate healthcare data as part of its investigations into fraud.
Galeotti and Dr. Mehmet Oz, Centers for Medicare and Medicaid Services administrator, also used the press conference to make a plea for more tips.
“We need your help, the American people,” Oz said. “Why? Over half of the whistleblower tips that we get are for healthcare fraud and over half of the fraud against our government is in healthcare.”
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