On June 30, 2025, the Department of Justice announced the results of its 2025 National Health Care Fraud Takedown, the largest in the program’s history. The DOJ charged 324 defendants in connection with fraud schemes totaling more than $14.6 billion in intended losses to federal healthcare programs.
Among the cases was a coordinated set of charges against transnational criminal organizations operating out of Russia and Eastern Europe that had used U.S.-based shell companies to submit fraudulent Medicare claims, and a separate cluster of charges involving AI-generated recordings that falsely purported to capture Medicare beneficiaries consenting to receive medical products.
The scale of the 2025 Takedown reflects an enforcement environment that has only grown more aggressive since the COVID-19 pandemic ended. Many of the fraud schemes that emerged during the pandemic, built on emergency billing waivers, expanded telemedicine access, and programs for uninsured patients, did not end when those programs did. They continued, and in some cases intensified, as fraud networks adapted their operations to outlast the emergency conditions that first enabled them.
In fiscal year 2025, the DOJ recovered more than $5.7 billion from healthcare-related False Claims Act matters, the highest healthcare recovery total in the history of the statute. If you work in healthcare and have witnessed fraudulent billing, kickback arrangements, or falsified documentation submitted to Medicare or Medicaid, the government needs to hear from you.
What the Pandemic Created and Left Behind
The COVID-19 pandemic produced an extraordinary expansion of federal healthcare spending. Congress authorized emergency funds for testing and treatment of uninsured patients, relaxed restrictions on telemedicine billing, and extended Medicare coverage to services that would not otherwise have qualified for reimbursement. These changes were necessary responses to a genuine public health emergency. They also created conditions that fraud networks were quick to exploit.
The DOJ has pursued pandemic-related fraud continuously since those emergency programs launched, and enforcement has not tapered off. In fiscal year 2025 alone, the government obtained more than 200 settlements and judgments totaling more than $230 million in connection with pandemic fraud allegations. To date, the DOJ has recovered more than $820 million in civil settlements and judgments tied to pandemic-era billing abuse, and investigations remain open.
The Fraud Schemes That Have Persisted
The patterns driving enforcement actions today are largely the same ones that emerged during the pandemic years, now running through the infrastructure of telehealth platforms, clinical laboratories, and durable medical equipment suppliers that expanded rapidly between 2020 and 2022. These include:
- COVID-19 testing fraud: Providers billed federal programs for uninsured patient testing without confirming insurance status, or submitted claims for tests that were never provided or not eligible for reimbursement. Urgent care provider CityMD paid more than $12 million to resolve these allegations.
- Telemedicine fraud: Fraud networks recruited physicians to authorize prescriptions and orders for patients they had never treated, then billed Medicare for those services. The 2025 Takedown charged 49 defendants with more than $1.17 billion in fraudulent telemedicine and genetic testing claims.
- Genetic testing fraud: Marketers solicited Medicare and Medicaid beneficiaries for unnecessary cancer screening and other genetic tests, obtained physician orders from providers with no treating relationship, and billed federal programs regardless of medical necessity. A multistate scheme of this kind resulted in more than $114 million in combined judgments and settlements.
- Wound care fraud: The 2025 Takedown included eight wound care cases, with one alone involving approximately $1.1 billion in allegedly fraudulent claims. Common schemes include billing for treatments not provided and targeting elderly or terminally ill patients.
- Durable medical equipment fraud: Suppliers bill Medicare for equipment that was never ordered by a treating physician, was not medically necessary, or was never delivered. Telehealth platforms have made it easier to generate high volumes of fraudulent equipment orders quickly.
- Opioid and controlled substance diversion: The 2025 Takedown charged 74 defendants for diverting more than 15 million pills. Walgreens paid $300 million in April 2025 to resolve allegations that it filled invalid controlled substance prescriptions and billed federal healthcare programs for those claims.
The government depends on insider knowledge to detect and pursue billing and healthcare fraud. Federal agencies process billions of claims each year and cannot independently verify the clinical basis for each one. The people who can are those working inside the healthcare organizations that submit those claims.
Speak with a Whistleblower Attorney
If you have knowledge of fraudulent Medicare or Medicaid billing, whether it involves COVID-related testing, telemedicine, genetic testing, wound care, durable medical equipment, controlled substances, or any other scheme, you may be entitled to file a qui tam complaint and share in the government’s recovery. Federal law also protects whistleblowers from retaliation for reporting fraud.
The whistleblower attorneys at Keller Grover represent clients in False Claims Act cases involving healthcare fraud across a range of settings and specialties. Contact our legal team today to discuss any information you have and understand your legal options.