In an unprecedented operation leveraging AI and data analytics, the U.S. Department of Justice (DOJ) executed the largest healthcare fraud takedown in history, charging 324 individuals across 50 districts with schemes totaling $14.6 billion in intended losses.

Using proactive data analytics, the Health Care Fraud Unit’s Data Analytics Team and its partners identified abnormal billing patterns, enabling the Department of Health and Human Services Office of Inspector General (HHS-OIG) and the Centers for Medicare and Medicaid Services (CMS) to block nearly all of the $4.45 billion in fraudulent Medicare payments — allowing only about $41 million to be disbursed before the scheme was uncovered.

“Through advanced data analytics, real-time monitoring, and swift administrative action, CMS is leading the fight to protect Medicare, Medicaid, and the trust Americans place in these vital programs. We’re not waiting for fraud to happen — we’re stopping it before it starts,” CMS Administrator Dr. Mehmet Oz said.

The crackdown, dubbed Operation Gold Rush, exposed transnational criminal syndicates that exploited stolen identities and shell companies to submit bogus Medicare claims, including a $10 billion urinary catheter scam.

Notably, some defendants allegedly used AI themselves to create fake audio recordings of Medicare beneficiaries supposedly consenting to receive medical products. Investigators say this fraudulently generated data — combined with illegally obtained personal information—was sold to labs and equipment suppliers who used it to submit false claims.

Authorities also dismantled hundreds of telehealth and genetic testing fraud networks, opioid pill mills, and kickback schemes involving suburban clinics. Over $245 million in assets — including cash, luxury vehicles, and cryptocurrency — were seized.