The Department of Justice announced in New Jersey, medical professionals were among the 324 individuals charged in the Justice Department’s largest-ever health care fraud takedown, involving over $14.6 billion in alleged fraudulent claims nationwide.
The Department of Justice unveiled its largest health care fraud takedown to date, charging 324 individuals—including nearly 100 licensed professionals such as doctors, nurses, and pharmacists—with participating in schemes that involved over $14.6 billion in intended losses, according to a press release. The sweeping operation spanned 50 federal districts and 12 state attorneys general offices and reflects a major national effort to curb exploitation of Medicare, Medicaid, and private insurers. The crackdown also included civil cases against dozens of defendants and the seizure of over $245 million in illicit proceeds such as luxury vehicles, cryptocurrency, and real estate.
Accoding to the DOJ, in New Jersey, 15 individuals and entities were charged or reached settlements in connection with wide-ranging health care fraud schemes targeting Medicare, Medicaid, TRICARE, and private insurers. Defendants include Alan Vaughan, a UK national accused of orchestrating an $80 million telehealth kickback scheme, and Taejin Kim, a physical therapist who allegedly defrauded Amtrak’s health plan of over $2.2 million. Pharmacy owner Nestor Jaime was charged with submitting $2.5 million in false claims, while multiple pharmacies and a hospital system settled civil allegations involving undispensed drugs and unqualified providers.
“This record-setting Health Care Fraud Takedown delivers justice to criminal actors who prey upon our most vulnerable citizens and steal from hardworking American taxpayers,” said Attorney General Pamela Bondi. “Make no mistake – this administration will not tolerate criminals who line their pockets with taxpayer dollars while endangering the health and safety of our communities.”
According to the DOJ press release, individuals were charged in the following states: Arizona, California, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Mississippi, Montana, Nevada, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Vermont, Virginia, Washington, West Virginia, and the District of Columbia.
One of the most significant cases involved a global criminal network known as Operation Gold Rush, which used shell companies and stolen patient identities to file $10.6 billion in fraudulent claims for urinary catheters and medical devices. The operation featured foreign operatives deploying fake identities and encrypted messaging to purchase U.S.-based medical supply firms. Medicare was nearly defrauded of $4.45 billion, but rapid intervention prevented all but $41 million from being disbursed. Several arrests were made, including individuals captured in Estonia and at U.S. border crossings, and nearly $28 million has been recovered.
The takedown also exposed fraud rings that preyed on the elderly, the homeless, and individuals struggling with addiction. In Arizona and Nevada, practitioners billed $1.1 billion for medically unnecessary wound care treatments targeting hospice patients. 74 defendants across 58 cases were implicated in the illegal distribution of over 15 million prescription opioid pills. In Texas, one group distributed more than 3 million pills, fueling street-level drug trafficking. These schemes not only drained taxpayer funds but also endangered public health by worsening the opioid epidemic and misusing medical credentials.
