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Record Breaking Day

Healthcare-Medicare-15
Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

Possibly the biggest announcement regarding Medicare fraud cases ever made by the Justice Department occurred on June 30, 2025, “Largest Justice Department Health Care Fraud Takedown in History. More than Doubles Prior Record of $6 Billion.” The conclusion of this monumental health care fraud takedown resulted in record-breaking criminal charges against 324 defendants including 96, nurse practitioners, pharmacists, and other licensed medical professionals, for their alleged participation in various health care fraud schemes in 50 federal districts involving over $14.6 billion in stolen government benefits. One specific scheme in this takedown should be noted in part because it also breaks records being among the largest individual health care schemes in Medicare’s history. It’s a record-breaking day.

The specific scheme was carried out by 11 defendants, including citizens of the United States, Estonia, and the Czech Republic, who worked for a criminal organization based in Russia. The organization allegedly used a network of foreign straw companies and strategically bought dozens of medical supply companies located across the United States. They then rapidly submitted over $12 billion in fraudulent health care claims to Medicare for urinary catheters and other durable medical equipment by exploiting the stolen identities of over one million Americans spanning all 50 states. Hundreds of thousands of people were billed for medical equipment they didn’t ask for and their personal identifying information was compromised.

The organization allegedly exploited the U.S. financial system by laundering the fraudulent proceeds and deploying a range of tactics to circumvent anti-money laundering controls to transfer funds into cryptocurrency and shell companies located abroad. The arrests announced today also include a banker who facilitated the money laundering of fraud proceeds on behalf of the organization through a U.S.-based bank.

Great job with the Department of Health and Human Services, Office of Inspector General in this case.

Today’s Fraud of The Day is based on “U.S. Charges 11 in Russia-Based Scheme to Bilk Medicare of $10.6 Billion” published by the New York Times on June 27, 2025.

When hundreds of thousands of people enrolled in Medicare were billed for expensive medical equipment they never asked for in 2023, it was part of a $10.6 billion fraud, among the largest such schemes in the program’s history, federal prosecutors said this week.

The scheme was carried out by 11 defendants, including citizens of the United States, Estonia and the Czech Republic, who worked for a criminal organization based in Russia, according to an indictment unsealed in the Eastern District of New York on Thursday.

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