Sherry Cartechine (@SherryCartechine)

Like Dislike Medicare fraud involves intentionally submitting false information to obtain unauthorized payments, costing taxpayers an estimated $60 billion each year according to the FTC. What Medicare Fraud Looks Like Common forms of Medicare fraud include: Billing for services never provided, such as chronic care management or lab tests. Enrolling healthy individuals into hospice care without consent to bill Medicare, with schemes reaching billions in losses. Recent Examples A California hospice owner pleaded guilty after submitting over $2.2 million in false claims for patients who were not terminally ill. Nationwide investigations uncovered $3.5 billion in fraudulent hospice claims in Los Angeles County alone. CMS blocked or recovered more than $1.6 billion in fraudulent lab payments using AI-driven analytics. Medicare Fraud Enforcement and Layoffs Recent years have seen massive federal crackdowns on Medicare fraud, with the U.S. government reporting record enforcement actions and significant financial recoveries. These operations have also led to widespread layoffs and business closures among providers and suppliers found to be involved in fraudulent billing. Scale of 2026 Enforcement In June 2026, the Justice Department and HHS announced the largest combined federal and state healthcare fraud takedown in history, charging 455 defendants across 56 federal districts and 45 states, tied to over $6.5 billion in alleged false claims to Medicare, Medicaid, and other federal health programs Assets seized: Over $182 million in cash, luxury vehicles, and other property www.governmentenforcementreport.com www.governmentenforcementreport.com . Focus: Shift from the past “pay and chase” model to a “detect and prevent” strategy using AI and data analytics to stop improper payments before they occur www.governmentenforcementreport.com www.governmentenforcementreport.com . Patient harm: The campaign emphasized protecting patients in addition to recovering taxpayer funds www.governmentenforcementreport.com www.governmentenforcementreport.com . CMS Fraud Prevention and Suspensions Centers for Medicare & Medicaid Services (CMS) has been using data analytics and automated edits to identify anomalous billing patterns, suspending payments, and revoking provider enrollment. From FY 2022–2024, CMS prevented $11.9 billion in potentially fraudulent payments through administrative actions U.S. Government Accountability Office (U.S. GAO) U.S. Government Accountability Office (U.S. GAO) . In 2025 alone, CMS: Suspended 441 Medicare payments totaling over $3.4 billion Centers for Medicare & Medicaid Services Revoked billing rights for 4,075 providers/suppliers Centers for Medicare & Medicaid Services Denied 100,317 claims for unnecessary services Centers for Medicare & Medicaid Services Layoffs and Business Impacts While the government does not always publish exact layoff numbers, the scale of these takedowns means: Provider bankruptcies and closures are common when multiple facilities are hit by fraud charges. Staff layoffs occur as businesses shut down or restructure after being debarred from Medicare billing. The Medicare Fraud Strike Force and state Medicaid Fraud Control Units have been active in targeting durable medical equipment, hospice billing, and other high-risk areas How to Report Suspicious Activity Beneficiaries can report fraud, waste, or abuse by calling 1‑800‑MEDICARE or visiting CMS.gov/fraud Centers for Medicare & Medicaid Services Early reporting can help prevent further harm and may lead to faster action. In summary: The 2026 Medicare fraud takedown and ongoing CMS enforcement have significantly disrupted the healthcare sector, with thousands of providers facing charges, suspensions, revocations, and in many cases, layoffs or closures. These actions are part of a broader “detect and prevent” strategy aimed at stopping fraudulent payments before they occur. Mother and Daughter Arrested for Medicaid Fraud and Grand Theft TALLAHASSEE, Fla.-Attorney General Pam Bondi's Medicaid Fraud Control Unit today announced the arrests of a private duty nurse and her daughter for Medicaid provider fraud and grand theft in Bay County, Fla. Kimberly Mills, 49, while employed as a private duty nurse, allegedly stole more than $50,000 from her employer and submitted billing records of more than $100,000 for filing claims that are not reimbursable by Medicaid. According to the investigation, Kayla Moore, 28, Mills' daughter, aided and abetted her mother in the fraudulent filings. Read more on www.myfloridalegal.com Action Details Date:Aug. 24, 2015, midnight Agency:Florida Attorney General Enforcement Types: State Enforcement Agencies