Department of Justice Announces Biggest Health Care Fraud Case in U.S. History

What Happened?

Following an operation code named Gold Rush, federal law enforcement officials uncovered a conspiracy to purchase more than 30 health care supply companies that were already enrolled with Medicare. The alleged buyers then used those companies to submit thousands of claims for urinary catheters, continuous glucose monitors and other supplies that were not medically necessary. 

According to the Department of Justice, since 2022 the alleged conspirators have submitted false and fraudulent claims for medical supplies potentially valued at up to $5.5 billion dollars, making this the single largest health care fraud case in U.S. history.

Why it Matters

Health care fraud has been on the rise in the United States during the past decade, increasing costs and reducing the effectiveness of health care for millions of Americans. A common technique for fraudsters is to submit bills for real equipment or medicine that wasn’t ordered by doctors or that was just made up by the individual claimants. Operation Gold Rush revealed this same technique had been applied on a much larger scale than previously seen.

According to Dan Diamond and Lauren Weber of the Associated Press, federal officials were able to prevent more than 99 percent of the Medicare payments from reaching the alleged perpetrators. Instead, teams at the Centers for Medicare and Medicaid Services and HHS inspector general’s office quickly identified fraudulent bills, suspended payments to the suspected companies and partnered with federal agencies that launched Operation Gold Rush in 2023.

In order to submit fake invoices that appear to be authentic, many fraudsters first must acquire personally identifying information for people who are actual Medicare or Medicaid recipients. By using real patients’ information, scammers can sometimes trick the federal billing system into thinking the charges are legitimate. This not only drives up costs for taxpayers, but it can lead to increases in costs for equipment and medication due to scarcity for non-Medicare and Medicaid patients as well.

What made this particular scam easier for government officials to spot was the huge volume of equipment the fraudsters tried to get the government to pay for. One example involved catheters. ‘I don’t even know if the United States has the ability to manufacture 1 billion catheters in such a short time,’ said Isaac Bledsoe, director of strategic projects and initiatives at the Department of Health and Human Services’ inspector general’s office. Because the scammers got greedy and ordered more catheters than the U.S. has people, it made the fraud easier to detect. 

How it Affects You

Health care fraud raises costs for everyone and prevents people who need care from receiving it in a timely fashion. If you receive letters in the mail or receipts documenting equipment you didn’t use or medication you didn’t order, contact federal law enforcement authorities immediately.