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…
PAYROLL & HR CONTROLS (PREVENTING “GHOST” SCHEMES)
Payroll fraud is often the hardest to detect because it “looks” like a normal business expense.
- Segregation of Duties (SoD): The person who adds new employees to the system must not be the same person who approves the monthly pay run.
- Mandatory Vacation Policy: Require all financial and HR staff to take 5–10 consecutive days of leave annually. Fraud often surfaces when the perpetrator isn’t there to “hide” the trail.
- Ghost Employee Audit: Perform a quarterly “Headcount Reconciliation” where managers must physically verify every name on their payroll list exists.
- Self-Pay Blocking: Ensure the payroll software has a hard-coded block preventing administrators from editing their own salary or bank details.