NAFA Salutes DOJ for Huge Takedown of Healthcare Fraud

There’s probably no lower brand of thief than one who will steal from the sick and elderly. Yet, Medicare and Medicaid fraud is a multi-billion dollar per annum business in the United States, threatening vital services for the most vulnerable members of our society. That’s why those of us in the business of stopping fraudsters were delighted to hear the announcement from the U.S. Department of Justice on Monday, June 30, 2025, of the largest healthcare fraud enforcement action in U.S. history.

The National Health Care Fraud Takedown charges that 324 defendants across 50 federal districts had conspired on schemes to defraud government health programs of more than $14.6 billion. The takedown seized $245 million in assets, including cash, luxury vehicles, and cryptocurrency, and prevented $4 billion in fraudulent claims. Key components of the sweeping fraud scheme included:

• Urinary catheter scheme ($10.6 billion) — A transnational criminal organization used stolen identities and straw owners to acquire medical supply companies, filing fake Medicare claims for unnecessary catheters. Nineteen defendants, including four in Estonia, were charged.
• Arizona Medicaid fraud ($650 million) — Farrukh Jarar Ali’s ProMD Solutions allegedly enrolled 41 substance abuse clinics in Arizona’s Medicaid (AHCCCS), billing $650 million for unprovided or substandard services, targeting homeless and Native American populations. Ali, based in Pakistan, faces conspiracy, wire fraud, and money laundering charges.
• Opioid trafficking — Seventy-four defendants, including 44 medical professionals, were charged for diverting over 15 million prescription opioid pills, such as oxycodone, often through virtual clinics misrepresenting patient care.
• Telemedicine and genetic testing ($1.17 billion) — Forty-nine defendants submitted fraudulent Medicare claims for unnecessary tests via telemedicine schemes.
• New Jersey fraud ($14.2 million) — Fifteen defendants, including physicians and pharmacies, faced charges for billing unneeded drugs, devices, and tests, or receiving kickbacks for fake prescriptions.

As a result, 324 defendants, including 96 doctors, nurses, and pharmacists, face criminal charges such as healthcare fraud, wire fraud, and money laundering. Penalties could include up to seven years in prison per count under 18 U.S.C. § 1347.

Twenty defendants face $14.2 million in civil fraud claims, with 106 others having already settled for $34.3 million. The Centers for Medicare and Medicaid Services also suspended billing privileges for 205 providers.

Attorney General Pam Bondi emphasized accountability, and committed the DOJ to continuing its proactive approach to protecting healthcare programs by combatting fraud.

Fraud is never a victimless crime

Criminals can equivocate all they want about how harmless defrauding the government is. Sure, they’re not sticking a gun in anyone’s face, but depleting funds directly tied to services that keep people alive produces the same outcome. And whether fraud is perpetrated against the government or a private entity, innocent individuals and society at large are harmed.

In the private sector, insurance fraud costs billions each year. That means lower profits for insurers, but it also means higher premiums and poorer service for policyholders. Whether you’re an insurer or policyholder, you have a vested interest in stopping insurance fraud, and North American Forensic Accounting has the expertise to help.

NAFA uncovers insurance fraud in business interruption claims

At NAFA, we’re frequently called on by insurance companies to provide investigative insight and analytical prowess to detect, quantify, document, and deter insurance fraud. In one recent instance, an insurer asked our NAFA team to review a business interruption (BI) claim submitted by an independent pharmacy impacted by a fire. The insurance company was suspicious of the amount claimed. Our NAFA team quickly concluded the numbers made no sense. Further review made it clear that the BI claim was highly inflated. The result – significant savings for the insurance company and ultimately prosecution of the fraudsters.

The Expertise You Need for Insurance Fraud investigations

NAFA specializes in identifying fraud schemes across a wide spectrum of Industries from banking to healthcare to auto and property claims and more. We assist clients with:

• Claims validation — We analyze financial records, invoices, and supporting documentation to assess the accuracy and legitimacy of insurance claims. We then can detect patterns of inflation, misrepresentation, and fabrication.
• Litigation support and expert testimony — Our credentialed experts present complex financial findings in court-ready reports and offer authoritative testimony to support legal proceedings.
• Financial loss reconstruction — We quantify actual economic losses through detailed reconstruction of books, ledgers, and revenue streams, helping distinguish between legitimate and fraudulent losses.
• Internal fraud risk reviews — We can help insurers and large policyholders evaluate internal controls and implement measures to reduce exposure to fraud.

NAFA employs Certified Fraud Examiners (CFE’s), CPAs, experienced investigators, and business subject-matter experts. We can assemble a highly qualified team tailored to your specific needs. NAFA employs court-tested methodologies and reporting standards. We conduct discreet, efficient investigations with clear, evidence-based reports of findings.

Protect your claims process by contacting NAFA today

Partner with North American Forensic accounting to identify and quantify fraud, mitigate exposure, and help ensure integrity across your insurance system. Contact us today.