全国医保诈骗清剿：455名被告被起诉，涉虚假申报逾65亿美元
2026年6月23日，美国司法部宣布2026年全国医保诈骗清剿行动成果：455名被告被起诉，其中包括90名医生及其他持牌医疗专业人员，被控参与的医保诈骗虚假申报总额超过65亿美元。案件遍及56个联邦司法区、45个州及领地，全部50个州的 Medicaid 诈骗控制单位均参加行动，为司法部历史上规模最大的一次。执法部门查扣现金、豪车、珠宝等资产逾1.82亿美元。司法部强调，上述均为指控，被告在被定罪前推定无罪。
最大的一组案件是伤口护理诈骗：11名被告在6个司法区被起诉，涉及羊膜异体移植产品。其中亚利桑那州一案中，供方被控就一家公司的产品向 Medicare 申报逾40亿美元、实付逾20亿美元，产品以最高达2,000%的加价转售，约40%被指用作非法回扣。德克萨斯州南区一名执业护士被控9.06亿美元的同类骗局。其他被点名的案件包括伊利诺伊州6,700万美元的 Medicaid 行为健康骗局、加利福尼亚州中区2,770万美元的临终关怀骗局（被控向殡仪馆员工购买刚逝者信息），以及佛罗里达州南区8,900万美元的不必要心血管检查骗局，其中一名学生运动员患者已经死亡。
刑事起诉之外，联邦医疗保险与医疗补助服务中心（CMS）暂停了1,079家供方、撤销了1,403家的计费资格，48件民事金钱和解合计逾7,300万美元。司法部表示，两周内通过国际协作，自塞浦路斯、爱沙尼亚与菲律宾带回多名被告，其中包括一名 FBI 头号通缉诈骗犯。
455 Charged in National Health Care Fraud Takedown Involving Over $6.5 Billion in Alleged False Claims
The Justice Department announced the 2026 National Health Care Fraud Takedown on June 23, 2026, charging 455 defendants, including 90 doctors and other licensed medical professionals, over their alleged participation in health care fraud schemes involving more than $6.5 billion in false claims. The cases span 56 federal districts and 45 states and territories, with all 50 state Medicaid Fraud Control Units participating, the most in Department history. The government seized more than $182 million in cash, luxury vehicles, jewelry and other assets. All charges are allegations, and defendants are presumed innocent unless proven guilty.
The largest scheme cluster involved fraudulent wound care: 11 defendants across six districts were charged over amniotic allografts, including an Arizona case in which providers allegedly billed Medicare more than $4 billion for one company's products, with more than $2 billion paid, the products resold at mark-ups of up to 2,000 percent and about 40 percent allegedly paid out as kickbacks. In the Southern District of Texas, a nurse practitioner was charged in a $906 million allograft scheme. Other cases included a $67 million Illinois Medicaid behavioral-health scheme, a $27.7 million hospice scheme in the Central District of California in which information about recently deceased patients was allegedly bought from a funeral home employee, and an $89 million scheme in the Southern District of Florida involving unnecessary cardiovascular tests on student athletes, one of whom died.
Alongside the criminal charges, the Centers for Medicare and Medicaid Services suspended 1,079 providers and revoked billing privileges for 1,403, and 48 civil monetary settlements totaled more than $73 million. Over a two-week period, international cooperation brought back defendants from Cyprus, Estonia and the Philippines, including one of the FBI's most wanted fraudsters, the Department said.
来源：美国司法部
发布：GSM·美国（发布链接）
图片来源：图：美国司法部总部 Robert F. Kennedy 大楼（华盛顿特区）。Baseball Watcher 摄，CC BY-SA 3.0，经 Wikimedia Commons。 / Photo: Robert F. Kennedy Department of Justice Building, Washington, D.C. Photo by Baseball Watcher, CC BY-SA 3.0, via Wikimedia Commons.
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