As Paragon’s Health Care Fraud Dashboard continues to demonstrate, fraud drains billions of dollars every year from federal health programs, harming patients and taxpayers. Between June 13 and 26, the Department of Justice (DOJ) moved on several fronts: it announced one of the largest coordinated fraud enforcement actions in history, sued a state Medicaid program, and brought a steady stream of charges, convictions, and settlements.
Major fraud cases included:
DOJ announced its 2026 National Health Care Fraud Takedown, charging 455 defendants with health care fraud and opioid schemes involving more than $6.5 billion in false claims across 45 states and territories. CMS suspended 1,079 providers and revoked billing privileges for another 1,403. Medicaid fraud was a focus: prosecutors charged 295 defendants with more than $518 million in alleged false claims, the largest Medicaid fraud total in DOJ history. (June 23)
Takedown cases included:
In Louisiana, a lab sales representative was charged with conspiracy for causing the submission of more than $51.7 million in claims for medically unnecessary respiratory testing, and a physician was charged with fraud in connection with a scheme to bill Medicare at least $5.9 million for care not provided.
In Hawaii, a pharmacist was charged in a scheme to bill Medicare for prescription drugs never dispensed, causing a loss of at least $1.5 million.
In Oregon, a lab owner was charged over fraudulent claims submitted to Medicare Advantage plans for genetic testing, causing a loss of more than $15 million, and the owner of two diagnostic companies was charged over fraudulent sleep test claims to HHS, the VHA, and private insurers, causing a loss of at least $2.1 million.
In Arizona, a VP of sales was charged in connection with a $1.2 billion skin substitutes scheme involving Medicare, TRICARE, CHAMPVA, and commercial insurers, and a substance abuse treatment clinic owner was charged in connection with a scheme to bill Arizona Medicaid for more than $44 million.
DOJ filed a civil lawsuit against the New York State Department of Health, Medicaid Director Amir Bassiri, and Public Partnerships LLC (PPL), alleging fraud in New York’s $10 billion Consumer Directed Personal Assistance Program (CDPAP). DOJ alleges New York rigged the bidding process to favor PPL as the state’s single fiscal intermediary, misled the public, then let PPL bill unauthorized amounts. “New York’s backroom deal with PPL has cost taxpayers millions of dollars and cast countless Medicaid patients to the curb.”—Assistant Attorney General Colin McDonald (June 16)
The owner of a California-based laboratory pleaded guilty to paying illegal kickbacks in a scheme that submitted more than $85 million in false claims to Medi-Cal and more than $11 million to Medicare. James Shuford Price III ran Golden Star Labs (GSL) in Los Angeles, which paid “collectors” based on sample volume to source fake test specimens acquired from Medi-Cal and Medicare beneficiaries under fraudulent circumstances, including identity theft. (June 24)
An Arkansas laboratory and its owners agreed to pay $30 million to settle allegations that they billed federal health care programs for medically unnecessary testing and paid illegal kickbacks to gastroenterology practices for referrals. Advanced Pathology Solutions PLLC allegedly set up limited-purpose laboratories inside gastroenterology practices nationwide, gave them benefits for exclusive referrals, and directed staff to order special tests before a pathologist reviewed their necessity. (June 17)
A Louisiana nurse practitioner was sentenced for causing more than $12 million in false and fraudulent claims to Medicare for unnecessary cancer genetic tests. Scharmaine Lawson Baker signed hundreds of orders for unnecessary tests, including ovarian and cervical tests for male patients, after phone calls typically under 30 seconds, without examining the patients, and in exchange for kickbacks and bribes from the telehealth company she worked for. (June 17)
Two urologists agreed to pay $2.2 million to settle claims that they billed Medicare for medically unnecessary implantations of a device used to treat urinary incontinence. Dr. Robert Simon of New Jersey and Dr. Nicole Fleischmann of New York admitted implanting the device—sometimes two at once—without the testing Medicare requires to confirm it would help. Simon also billed for unnecessary battery-replacement and revision surgeries. (June 25)
An Ohio physician was sentenced for participating in a scheme that billed Medicare more than $1.8 million for unnecessary durable medical equipment and genetic testing. Working as an independent contractor for a Georgia-based telemedicine company, Muna Orra did not meaningfully review patient records or conduct required in-person assessments, despite signing orders indicating that she had done so. (June 15)
A California woman pleaded guilty to submitting close to $1 million in fraudulent claims to Federal Employees Health Benefits (FEHB) plans for hearing-protection devices disguised as medically necessary hearing aids. Julianna Lung sold the devices to Border Patrol agents, other federal employees, and their families as simple hearing protection, then submitted claims falsely representing that the patients had hearing loss or tinnitus requiring treatment. (June 25)
Cases continue to surface weekly, underscoring the scale of fraud and the intensifying federal effort to root it out. Keep up to date with our Health Care Fraud Dashboard.
