Healthcare fraud: Hundreds charged by DOJ
Justice Department officials announced they are charging 455 defendants over schemes involving more than $6.5 billion in alleged false claims.
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The U.S. Department of Justice has charged more than 450 people — including more than two dozen Missouri residents — in connection with global health care fraud schemes totaling a record $6.5 billion.
The DOJ wrote in a news release on June 23 that the alleged fraud and opioid abuse schemes involved 455 people across 45 states who submitted false claims to Medicare, Medicaid and other health care programs and “caused significant patient harm, including death.” Ninety doctors and other licensed medical professionals are among those charged in the schemes.
In all, 56 federal districts and 50 state Medicaid Fraud Control Units participated in the investigation ― the most in the DOJ’s history.
“Health care fraud steals from taxpayers, exploits vulnerable patients, and puts lives at risk,” U.S. Department of Health and Human Services Secretary Robert F. Kennedy, Jr. said. “Today’s historic enforcement action sends a clear message: if you use our health care system to enrich yourself at the expense of patients or the American people, we will find you, we will prosecute you, and we will hold you accountable.”
Luxury cars, fine art and a hotel in the Philippines
Since June 8, hundreds of defendants have been arrested in connection with the schemes, in what the DOJ is calling the 2026 National Health Care Fraud Takedown.
In one case in Arizona, Acting Attorney General Todd Blanche said a corporate executive allegedly took $1 billion in taxpayer funds after billing for wound grafts and charging more than $1 million per patient. The money was later allegedly used to buy million-dollar homes, luxury cars and even build a hotel in the Philippines.
In another case in Florida, three defendants were charged for their roles in an $118 million allograft fraud scheme where a nurse practitioner allegedly used the proceeds to fund their lavish lifestyle, including a luxury box at an NFL stadium and over $400,000 in fine art.
How many Missourians have been charged in the 2026 National Health Care Fraud Take Down?
Twenty-four Missourians have been charged in the state for their alleged participation in health care fraud, with three others being charged out of state. The most common charges include “false statement to receive a health care payment” and “stealing by deceit in connection with Medicaid fraud.”
Two of the complaints allege that the accused parties fraudulently pocketed more than $100,000.
- Michelle Terry, 48, of Saint Peters, was charged with Medicaid fraud and stealing. Terry, who owns an adult daycare center, is accused of submitting false claims for purported services to four Medicaid recipients from May 2023 to September 2024, collecting $114,480.32 in Medicaid funds in the process.
- Chontell Wilkes, 34, and Sandra Wilkes, 55, of St. Louis, were charged with Medicaid fraud and stealing. The pair owns Smiles Adult Day Care, and are accused of submitting 1,418 false claims for adult day care services that were not provided. Through this scheme, Medicaid paid the Wilkeses more than $121,362.20 for services not provided.
In total, the cases cost the state more than $613,000, Missouri Attorney General Catherine Hanaway said in a news release.
What is health care fraud?
The U.S. Federal Bureau of Investigation states that health care fraud is defined as intentionally deceiving the health care system to receive illegal benefits or payments. It can be committed by medical providers, patients and other individuals.
What are the most common types of health care fraud?
The FBI lists the following as some of the most common types of health care fraud committed by medical providers:
- Double-billing: Submitting multiple claims for the same service.
- Phantom billing: Billing for a service visit or supplies that the patient never received.
- Unbundling: Submitting multiple bills for the same service.
- Upcoding: Billing for a more expensive service than the patient actually received.
Common types of fraud committed by patients and other individuals include:
- Bogus marketing: Convincing people to provide their health insurance identification number and other personal information to bill for non-rendered services, steal their identity, or enroll them in a fake benefit plan.
- Identity theft/identity swapping: Using another person’s health insurance or allowing another person to use your insurance.
- Impersonating a health care professional: Providing or billing for health services or equipment without a license.
Common types of fraud involving prescriptions included:
- Forgery: Creating or using forged prescriptions.
- Diversion: Diverting legal prescriptions for illegal uses, such as selling your prescription medication.
- Doctor shopping: Visiting multiple providers to get prescriptions for controlled substances, or getting prescriptions from medical offices that engage in unethical practices.
