DOJ uncovers $14.6 billion healthcare fraud that Biden missed
You have been robbed!!! Billions of dollars of your taxpayers’ money is gone. And it turns out that the “myth” of healthcare fraud—so often dismissed by Democrats as a right-wing talking point—just got a $14.6 billion reality check. In what the Department of Justice (DOJ) is calling the largest healthcare fraud takedown in U.S. history, more than 324 individuals, including 96 licensed medical professionals, were charged across 50 federal districts for their roles in a sprawling web of deceit, theft, and exploitation of the American healthcare system.
But let us not rush to celebrate just yet. While the Trump DOJ is deservedly taking bows, the real question is: Where was the Biden administration while this fraud metastasized into a multi-billion-dollar cancer? The numbers are staggering:
- $14.6 billion in intended fraudulent losses.
- $2.9 billion in actual losses.
- $245 million in seized assets, including cash, crypto, and luxury cars.
- $4 billion in fraudulent claims stopped by CMS.
- 205 providers had their billing privileges suspended or revoked.
The schemes ranged from telemedicine scams and fake addiction treatment centers to transnational criminal rings laundering Medicare dollars through shell companies and cryptocurrency.
One particularly grotesque case involved a Pakistani national who allegedly conspired with 41 addiction clinics in Arizona to bill Medicaid for services never rendered – many of which targeted Native American communities and the homeless.
Another gem! “Operation Gold Rush,” a $10.6 billion scheme involving Russian and Estonian nationals who used stolen identities of over a million Americans to submit fake Medicare claims for urinary catheters. (That should piss you off.) Nothing says “healthcare equity” like international crime syndicates billing Medicare for medical equipment no one ordered.
Attorney General Pamela Bondi and FBI Director Kash Patel declared it a “decisive moment” in the fight against healthcare fraud. For sure, it’s a big bust, but let’s not forget that this fraud didn’t happen overnight. It festered for years under the noses of the Medicare and Medicaid bureaucrats – and while the Biden administration was busy assuring the American people that fraud in government-run healthcare was “rare” and “overblown.” Apparently, $14.6 billion is just a rounding error when you’re spending trillions.
This isn’t just a failure of enforcement—it’s a failure of ideology. For years, Democrats have insisted that expanding government control over healthcare would not create a problem of waste, fraud, and abuse. They’ve mocked concerns about Medicare fraud as partisan fearmongering. And yet, here we are, with the largest fraud bust in American history.
Where was the oversight? Where were the audits? Where was the “most transparent administration in history” when foreign nationals were using AI-generated voice recordings to fake Medicare consent calls?
To their credit, the DOJ is now launching a Health Care Fraud Data Fusion Center to use AI and cloud computing to detect fraud. Why now and not three years ago, when these schemes were already in full swing? Why was the Trump administration able to again (referring to securing the border) do in months what the Biden administration was unable to do in years?
Let us be clear, every dollar stolen is a dollar not spent on real care for real patients – or maybe a dollar that Uncle Sam did not have to take from the taxpayers. Every fake claim undermines the integrity of programs like Medicare and Medicaid. And every time the government fails to detect fraud, it gives ammunition to those who argue that centralized healthcare is a bureaucratic disaster exposed to waste, fraud and abuse. And honestly, can you blame them?
This takedown should be a moment of reckoning—not just for the criminals, but for the policymakers and bureaucrats who had allowed this fraud to develop and rage on through negligence, denial, and ideological blindness. The Biden administration cannot have it both ways. You certainly cannot keep telling the American people that fraud is “not a serious issue” when $14.6 billion walked out the door under your watch.
Healthcare fraud is not a fiction. That should be kept in mind when those same Democrats tell us today that waste, fraud and abuse are not a problem in Medicaid. The next time someone tells you that healthcare fraud is a “myth,” point them to the 324 defendants now facing federal charges … or the one million stolen identities used to rip off we taxpayers.
If this is what “rare” healthcare fraud looks like, I’d hate to see an example of what real fraud in Medicare and Medicaid might look like. Oh, we just did.
So, there ‘tis.
Operation Gold Rush was started years ago, under Biden. It’s biggest haul before this was $6.9B under Biden.
Not one news agency i can find is blaming Biden or Democrats as the author devolves into.
BUSTED.
I spell my name: d a n g e r. If the author wants to spin the truth, do better.
Remember what’s important in all this. It’s not how good Trump is, it’s how bad Biden was.
The author’s true mission in life: “And every time the government fails to detect fraud, it gives ammunition to those who argue that centralized healthcare is a bureaucratic disaster exposed to waste, fraud and abuse. And honestly, can you blame them?” Well, the author cannot. So, destroy, destroy, destroy. Don’t fix what’s broken, throw the baby out with the bath water. What would you do with the author’s “bureaucratic disaster?” Does the author have a better idea? Because IMO, throwing the baby out with the bath water is not the answer. Frankly, after ObamaCare, I am ready for Universal Healthcare, or Medicare for all —– as a basic inalienable US right to good healthcare.
My goal: no American should go bankrupt just because they get sick.
I would rather struggle with some fraud from a large, centralized, government-controlled system than go back and face the current struggle in a system with government, private insurers, the industry itself, the specialists, and the rest of the mess. I lived with private-insurer “Cadillac” corporate plans in my career having 10% premium increases year after year starting with Reagan, higher copays and deductibles, less control, more constraints. Now I am on Medicare with a supplemental, and I rarely see a bill, can see any doctor I want, payout far less in premiums, it’s just all remarkably better and I wish for all to have the level of care and cost that I do under Medicare. The Republicans never had a good idea; the Democrats did.
The goal of our healthcare right: no American should go broke because they got sick.
I am glad they caught these folks, got some money back, and will note: the INTENDED loss was $14.6B and $4B of these claims were just stopped. A total of 99% of all of these fraud claims were stopped before payment by the government, according to Newsweek. Private insurers lost about $1B for supplemental insurance plans. The actual or real loss was $2.9B of which close to $.25B has been recovered though seizure.
Let’s put this in perspective: Medicaid is $870B a year, the real loss here was $2.9B or .0033%. At the INTENDED loss of $14.6B, it’s .016%. “Apparently, $14.6 billion is just a rounding error when you’re spending trillions” says the author who overlooks that similar losses found in Trump 1.0. He is correct. Not to mention that Medicaid isn’t even where most Federal fraud is found but the author forgets. Well, while it’s really $2.9B in real cost, and whether you use the real cost or intended loss, it is a rounding error, I agree, a big number. I agree, still important to stop. More important, let’s focus first on where the fraud is the largest: DOD and prioritize catching these criminals where they do the most harm.
This fraud was .016% of the Medicaid budget. A large number, but a small percentage. The total estimate of fraud for the US BUDGET is 7%. One of the greatest offenders is DOD. That does not mean that we should overlook, or look the other way; it’s good to arrest the offenders. But I would no more like to end Medicare/Medicaid for fraud any more than I would end the military because of more fraud. Well, except for Hegseth, this drunk can go.
I like the PR “good TV” aspect of this one by bundling the arrests, advertising, and hopefully deterring future attempts. *https://www.gao.gov/products/gao-24-105833* shows total fraud. For the DoD, Republican Grassley on the fraud: *https://www.grassley.senate.gov/news/news-releases/grassley-sanders-make-bipartisan-push-to-audit-the-pentagon-and-curb-wasteful-spending*
Unlike the author who oft times pisses and moans, blames Biden and Democrats, and has absolutely nothing to offer to help, I found that Newsweek made four recommendations, most of which are being killed by Trump.
1. Strong, experience, nonpartisan IG’s: Trump is firing instead of hiring.
2. Strengthen our data harvesting and analytics: this has been talked about for over a decade. Trump is turning down these systems or turning them over to DOGE kids.
3. Focus on global criminals noted by the international sources on this go round. Again, this has been talked about for over a decade
4. Quit focusing on “pay-and-chase” model where we only go after folks after we payout. This is the biggest outcome from the latest bust and, IMO, our most important tool.
Operation Gold Rush may have been started with Biden, he pulled the first $6.9B record bust in, but Team Trump deserves credit for this record-breaking version of Operation Gold Rush and the new “Health Care Fraud Data Fusion Center to use AI and cloud computing to detect fraud” for which the author asks: “Why now and not three years ago.” Why not 7 or 11 years ago? Stupid question but this new center, the use of AI, seems to represent a shift in how the federal government addresses fraud and hopefully we will move from “pay-and-chase” to proactive curtailment of fraud before payment. However, while the IG community has long urged agencies to shift from pay-and-chase to instead implementing anti-fraud measures before issuing payments, those IGs are gone now. Fired. Trump has shrunk IGs by 25%, and the rest are putting their resumes out while not exactly being productive. What would you do if 1 out of 4 of you were fired? With more to come? We may need to delay or slow payments to reduce fraud. But with AI and sophisticated data analytics tools, the IG community and feds can better triage claims before payment to prevent fraud and still pay claims relatively quickly. Credo’s to Team Trump for this accomplishment doing the right thing, the right way. The PR advertising aspect is bold, and I think a great deterrent. However, this shows the importances of brilliant inspector generals to fight against fraud and stay ahead of ever more sophisticated international crime rings stealing money. Instead, we fired 25% of the igs that made this possible. Time to put them back to work or this might be our last gold rush.
FYI: Like AI can improve Medicare/Medicaid fraud detection before payment a real possibility because it can do the work of thousands of analysts, E-Verify can end the need to arrest and deport most of what we are doing saving thousands of masked, jack-booted thugs,,. IF you can’t work, you can’t survive, you can’t stay. Just not sure why Trump is not jumping on these automated solutions versus expensive methods requiring massive amounts of human resource. I just don’t see the alure of using ICE when E-verify is better and cheaper. Let the author, and others, speak to that. Discuss….please.