The annual National Health Care Fraud Takedown, announced by the Department of Justice (DOJ) on June 23, 2026 (the “2026 Takedown”), reinforces several enforcement priorities — opioid diversion, wound care fraud, and kickback schemes — while signaling a sharper focus on Medicaid fraud and the government’s expanding use of advanced data analytics.
Large-Scale Enforcement Remains the Baseline
The 2026 Takedown resulted in charges against 455 defendants — including 90 physicians and other licensed medical professionals — in connection with more than $6.5 billion in alleged false claims. It spanned 56 federal districts and 45 U.S. states and territories. Of note, the DOJ highlighted that all 50 state Medicaid Fraud Control Units (MFCUs) participated, which may have been a result of the added scrutiny the administration is placing on MFCUs. The Centers for Medicare & Medicaid Services (CMS)…
Insurance fraud involves making false or exaggerated claims to an insurance provider.
- Hard Fraud: Someone deliberately causes a loss (e.g., setting fire to a warehouse or staging a car accident) specifically to collect a payout.
- Soft Fraud: More common and often viewed as “victimless” by the perpetrator. It involves exaggerating a legitimate claim, such as overstating the value of stolen items in a home burglary to cover the deductible.