Largest DOJ Takedown Highlights Urgent Need to Address Healthcare Fraud Risks

In June 2025, the US Department of Justice announced the largest coordinated healthcare fraud takedown in the nation’s history, reports Navex. The sweep charged 324 individuals in schemes totaling more than $14.6 billion, more than doubling the prior record of $6 billion. 

The alleged fraud spanned telemedicine, durable medical equipment (DME), genetic testing, addiction treatment, and prescription opioid trafficking. According to the DOJ, these schemes exploited technology and marketing channels “at the expense of patients and taxpayers.”

Navex notes that these incidents highlight systemic oversight and governance failures, particularly in smaller or decentralized healthcare organizations such as hospice, outpatient rehab, telehealth, and pharmacy services. As Clivetty Martinez of Granite GRC explains, these entities often lack the resources and infrastructure to enforce consistent compliance, leaving them more vulnerable to fraudulent practices and regulatory scrutiny.

Policy alone is insufficient. In many cases, compliance breakdowns arose from aggressive billing, misaligned incentives, ignored red flags, and weak reporting systems. Navex whistleblowing data indicates underreporting remains a persistent challenge, especially in low-resourced or geographically dispersed operations where employees may fear retaliation.

Jeffrey B. Miller of Granite GRC stresses that organizations avoiding DOJ scrutiny are not fortunate by chance but are deliberate in conducting risk assessments, monitoring billing across service lines, and empowering staff to report misconduct.

For compliance leaders, healthcare fraud is both a legal and reputational threat. Building a culture of ethics, supported by robust oversight and early detection systems, is essential not just to meet regulatory obligations but to safeguard organizational integrity and trust.