司法部史上最大医保诈骗清查 324人被起诉涉虚假申报逾146亿美元
2025年6月30日，美国司法部在华盛顿宣布2025年全国医保诈骗清查结果：324名被告被提起刑事指控，其中包括96名医生、执业护士、药剂师等持证医疗专业人员，案件分布在50个联邦司法区与12个州的总检察长办公室，涉案虚假申报的预期损失逾146亿美元。这是司法部历史上规模最大的医保诈骗清查，涉案金额是此前60亿美元纪录的两倍多。
司法部说，执法部门在行动中查封了逾2.45亿美元现金、豪华车辆、加密货币与其他资产。联邦医疗保险与医疗补助服务中心同时宣布，该中心在清查前的数月里拦截了逾40亿美元的虚假申报付款，并暂停或撤销了205家提供者的收费资格。行动还包括对20名被告的民事指控（涉案1,420万美元）与同106名被告达成的民事和解（合计3,430万美元）。
其中规模最大的一案被执法人员称为「淘金行动」（Operation Gold Rush）：一个跨国犯罪组织被指利用外国空壳业主在全美收购数十家医疗用品公司，盗用逾100万名美国人的身份与医疗信息，向联邦医保提交106亿美元的虚假申报，涉及导尿管等耐用医疗设备。19名被告在纽约东区等五个司法区被起诉，12人落网，其中4人在爱沙尼亚被捕；补充保险方已支付约9亿美元，执法部门已查封约2,770万美元赃款。
其余重点案件包括：74名被告（其中44名医疗专业人员）被指非法分流逾1,500万粒处方阿片类药物；49名被告涉逾11.7亿美元的远程医疗与基因检测虚假申报；7名被告被指针对临终关怀老人提交约11亿美元的羊膜伤口敷料虚假申报。
司法部长 Pamela Bondi 说，这次创纪录的清查是对那些侵害最脆弱公民、窃取勤劳纳税人钱财的犯罪分子的清算。联邦调查局局长 Kash Patel 说，本次查出的诈骗超过130亿美元，是这一行动历年来最大的一次。清查由司法部刑事局诈骗科医保诈骗组牵头协调，卫生与公众服务部监察长办公室、联邦调查局、缉毒局等机构参与；司法部同时宣布组建医保诈骗数据融合中心。加州中区、北区与南区等联邦检察官办公室也在承办名单之列。
司法部提醒，起诉书只是指控，所有被告在被法庭证明有罪之前推定无罪。
（来源：美国司法部）
DOJ Charges 324 Defendants in Largest Health Care Fraud Takedown in History, over $14.6 Billion in Alleged Fraud
On June 30, 2025, the U.S. Department of Justice announced in Washington the results of its 2025 National Health Care Fraud Takedown: criminal charges against 324 defendants, including 96 doctors, nurse practitioners, pharmacists, and other licensed medical professionals, in 50 federal districts and 12 State Attorneys General's offices, for alleged health care fraud schemes involving over $14.6 billion in intended loss. It is the largest health care fraud takedown in the Department's history, more than doubling the prior record of $6 billion.
The government seized over $245 million in cash, luxury vehicles, cryptocurrency, and other assets, the Department said. The Centers for Medicare and Medicaid Services announced that it had prevented over $4 billion from being paid on false and fraudulent claims in the months leading up to the takedown, and had suspended or revoked the billing privileges of 205 providers. The announcement also included civil charges against 20 defendants for $14.2 million in alleged fraud, and civil settlements with 106 defendants totaling $34.3 million.
The largest single case, known to law enforcement as Operation Gold Rush, involves a transnational criminal organization that allegedly used foreign straw owners to buy dozens of medical supply companies across the United States and exploited the stolen identities and confidential medical information of over one million Americans to submit $10.6 billion in fraudulent Medicare claims for urinary catheters and other durable medical equipment. Nineteen defendants were charged in the Eastern District of New York and four other districts; twelve were arrested, including four apprehended in Estonia. Medicare supplemental insurers paid approximately $900 million, and law enforcement has seized approximately $27.7 million in fraud proceeds.
Other headline cases include 74 defendants, among them 44 medical professionals, charged in connection with the illegal diversion of over 15 million prescription opioid pills; 49 defendants in telemedicine and genetic testing schemes involving over $1.17 billion in allegedly fraudulent claims; and seven defendants charged with approximately $1.1 billion in fraudulent claims for amniotic wound allografts applied to vulnerable elderly patients, many in hospice care.
Attorney General Pamela Bondi said the record-setting takedown delivers justice to criminal actors who prey upon the most vulnerable citizens and steal from hardworking American taxpayers. FBI Director Kash Patel said more than $13 billion in fraud was uncovered, the largest result for this initiative to date. The takedown was led and coordinated by the Health Care Fraud Unit of the Criminal Division's Fraud Section, with HHS-OIG, the FBI, the DEA, and other agencies; the Department also announced a new Health Care Fraud Data Fusion Center. The U.S. Attorneys' Offices for the Central, Northern, and Southern Districts of California are among the offices prosecuting the cases.
An indictment, information, or complaint is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
(Source: U.S. Department of Justice)
来源：美国司法部
发布：GSM·美国（发布链接）
图片来源：图：位于华盛顿特区的美国司法部罗伯特·肯尼迪大楼，司法部总部，本次全国清查由司法部刑事局诈骗科牵头协调。APK 摄，CC BY 4.0，经 Wikimedia Commons。 / Photo: The Robert F. Kennedy Department of Justice Building in Washington, D.C., headquarters of the U.S. Department of Justice, whose Criminal Division Fraud Section led and coordinated the nationwide takedown. Photo by APK, CC BY 4.0, via Wikimedia Commons.
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