The Justice Department (DoJ) has announced the results of its 2025 National Health Care Fraud Takedown, which resulted in criminal charges against 324 defendants for their alleged involvement in schemes exceeding $14.6 billion in intended loss.
The takedown effort involved Federal and state law enforcement agencies across the country, and it was powered in part by data analytics and artificial intelligence tools.
“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.”
As part of the takedown, the DoJ’s Health Care Fraud Unit’s Data Analytics Team – in partnership with the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG) for the Department of Health and Human Services (HHS) – prevented over $4 billion from being paid in response to false and fraudulent claims.
DoJ, along with CMS and HHS-OIG, detected the anomalous billing through proactive data analytics. They successfully prevented an organization from receiving all but about $41 million of the approximately $4.45 billion that was scheduled to be paid by Medicare.
In another action, defendants allegedly used AI to create fake recordings of Medicare beneficiaries appearing to consent to receive certain products.
According to court documents, the beneficiaries’ confidential information was then illegally sold to laboratories and medical equipment companies, which then used the data to submit false Medicare claims. The government seized about $44.7 million from various bank accounts related to this case.
“Through advanced data analytics, real-time monitoring, and swift administrative action, CMS is leading the fight to protect Medicare, Medicaid, and the trust Americans place in these vital programs,” said CMS Administrator Dr. Mehmet Oz. “We’re not waiting for fraud to happen – we’re stopping it before it starts.”
This week’s announcement also unveiled the launch of the Health Care Fraud Data Fusion Center. DoJ said it is working closely with HHS-OIG, the FBI, and other agencies to create the center, which will leverage cloud computing, AI, and advanced analytics to identify emerging health care fraud schemes.
The department said this initiative fulfills President Donald Trump’s March executive order that calls for increased inter-agency data sharing.