Healthcare fraud enforcement entered a new phase this year. On June 23, 2026, the Department of Justice announced charges against 455 defendants — including 90 doctors and other licensed medical professionals — for alleged schemes involving more than $6.5 billion in purported false claims. The Department described the takedown as the largest coordinated health care fraud action in its history, spanning 56 federal districts and 45 states and territories, with 50 state Medicaid Fraud Control Units (MFCUs) participating. As part of the same effort, the Government reported seizing more than $182 million in cash and assets, and CMS suspended or revoked the billing privileges of roughly 2,500 providers.
The National Fraud Enforcement Division Model
This most recent takedown is believed to be the first to be under DOJ’s new National Fraud Enforcement Division, created on April 7, 2026. The “Fraud Division” absorbed the Health Care Fraud Unit formerly housed in the Criminal Division and now serves as the enforcement arm of the whole-of-government Task Force to Eliminate Fraud, chaired by Vice President J.D. Vance.
A central component of operations remains the Health Care Fraud Strike Force program, which the Department has steadily expanded. Nine strike forces now operate across the country, including a newly launched West Coast unit covering Arizona, Nevada, and Northern California. Since the program’s inception in 2007, it has reportedly charged more than 6,200 defendants who collectively billed federal programs and private insurers over $45 billion.
Critically, strike forces in this most recent takedown have reportedly worked alongside fifty-six U.S. Attorney’s Offices and forty-five state Attorneys General. Under this model, national level monitoring and enforcement efforts can reach individual districts and provide strike force support.
DOJ reports an important new data analytics tool defining their recent efforts. The Fraud Division’s Data Fusion Center and its new Financial Intelligence Review Team combine claims data with financial analysis to flag billing outliers. Outliers may include a provider billing more counseling hours per day than its staff could deliver, or hospice billing patterns that suggest patients were not actually terminally ill. The Division reported that it utilizes cloud space inside CMS’s claims-data environment and signed data-sharing agreements with DHS and the FTC to facilitate to increased data needs.
Impact and Recent Healthcare Enforcement Trends in North Carolina
The Eastern District of North Carolina was among the districts that participated in the recent coordinated takedown effort, resulting in indictments for healthcare fraud. Along with ongoing healthcare related prosecutions in North Carolina, DOJ’s prioritization of these cases should signal an increase in fraud-related investigations.
The US Attorney’s Office for the Eastern District of NC announced an indictment resulting from Fraud Division efforts for a conspiracy that paid and received millions of dollars in illegal kickbacks for laboratory-testing referrals billed to Medicare, the Health Resources and Services Administration, TRICARE, and other payers through labs he owned or effectively controlled. To conceal the kickbacks, the defendant allegedly created dozens of sham contracts and invoices and used in-person marketing, meals, cash, and in-kind payments to drive referrals.
As part of the recent takedown, the US Attorney for the Eastern District announced an indictment in connection with a scheme to bill Medicare, CHAMPVA, TRICARE, and other programs for medically unnecessary DME such as braces and compression devices. According to the indictment, marketing entities solicited beneficiaries by waiving copays and deductibles, then sold beneficiary information and prefilled orders to suppliers who used a “doctor chase” model to pressure physicians into signing billable orders. Companies related to the defendant allegedly collected more than $14 million from Medicare alone..
A federal judge recently sentenced the operators of a substance-abuse and an affiliated drug-screening company in the eastern part of the state for a $12.7 million North Carolina Medicaid scheme that paid more than $1 million in gift-card kickbacks to patients struggling with addiction to generate billable visits and lab work. The defendants received prison terms totaling more than 14 years and the company was fined $15 million and ordered to be dissolved.
A Raleigh researcher and his company recently agreed to pay $152,500 to resolve allegations of false and duplicative claims received from National Science Foundation grants and PPP loans. Although criminal charges were avoided, the False Claims Act, which allows for treble damages and per-claim penalties, can often implicate healthcare providers as well as grant recipients and pandemic-relief borrowers.
The Takeaway
For providers and any business that receives federal funds, the lesson is detection is now analytics-driven and fast, marketing and referral arrangements and copay waivers are central to the government’s theories, and a single matter can generate parallel criminal, civil, and tax exposure. Robust compliance, documented medical necessity, careful vetting of marketing vendors, and prompt engagement of counsel at the first subpoena or civil investigative demand should be baseline steps for risk management.
