Canton Man Pleads Guilty in $4M Medicare DME Fraud Scheme
August 25, 2025 | JacobiJournal.com – A Canton man has pleaded guilty in a $4 million Medicare durable medical equipment (DME) fraud scheme involving medically unnecessary orthotic braces and deceptive telemarketing practices. The scheme is part of a broader federal crackdown under the $14.6 billion nationwide Healthcare Fraud Takedown. Federal prosecutors announced that a Massachusetts-based DME provider admitted to defrauding Medicare by billing for orthotic braces that were either not medically necessary or never provided to patients. The defendant, whose identity was released in court filings, used aggressive telemarketing tactics to obtain patient information and physician orders, often without proper medical evaluation. Between 2018 and 2022, the defendant submitted millions in false claims to Medicare for back, knee, wrist, and shoulder braces, resulting in more than $4 million in fraudulent reimbursements. How the DME Fraud Scheme Worked According to the Department of Justice, the Canton man paid overseas and domestic telemarketing companies to cold-call Medicare beneficiaries, offering free or low-cost medical equipment. Once the patient information was obtained, the scheme funneled bogus or forged prescriptions through complicit medical professionals. These orders were then billed to Medicare, even though many patients never received or needed the braces. The DME company also allegedly disguised kickbacks as “marketing fees” and “consulting payments” to conceal the fraud. Federal Crackdown and Takedown Operation This case is part of the U.S. Department of Justice’s 2025 National Healthcare Fraud Enforcement Action, which has resulted in criminal charges against over 200 individuals nationwide. The coordinated action targeted schemes involving telemedicine, DME fraud, pharmacy billing, and opioid distribution — with total intended losses exceeding $14.6 billion. DOJ Statement on the Guilty Plea “Healthcare fraud drains taxpayer dollars, endangers patients, and undermines trust in our medical system,” said Acting U.S. Attorney Joshua S. Levy for the District of Massachusetts. “This guilty plea sends a strong message to those exploiting Medicare: we will hold you accountable.” Sentencing for the defendant is scheduled for later this year. He faces up to 10 years in federal prison, restitution, and forfeiture of assets acquired through fraud. Workers, Patients & Providers: Know Your Rights Medicare beneficiaries are urged to report suspicious calls, billing statements, or unsolicited medical devices. Healthcare providers should maintain strict compliance programs and verify telehealth claims carefully. For full details on this case and other healthcare fraud enforcement actions, visit the U.S. Department of Justice – District of Massachusetts official press release section. FAQs: Canton Man Pleads Guilty Who is the Canton man that pleaded guilty in the Medicare DME fraud case? The man who pleaded guilty was the owner of a DME company that used telemarketing and false medical claims to bill Medicare for unneeded orthotic devices. What was the total amount involved in the DME fraud scheme? The man pleaded guilty to defrauding Medicare of over $4 million through false claims for unnecessary medical equipment. How does this DME fraud case connect to the nationwide healthcare fraud takedown? This DME fraud case is part of the broader $14.6 billion healthcare fraud takedown, which involved hundreds of defendants across the United States. What penalties could he face after pleading guilty? He could face up to 10 years in federal prison, restitution payments, and forfeiture of any assets obtained through the $4 million fraud. Stay ahead of fraud cases, legal updates, and compliance alerts. Subscribe to JacobiJournal.com today for trusted reporting on white-collar crime, healthcare enforcement, and regulatory actions. 🔎 Read More from JacobiJournal.com:
Fourth Circuit Upholds 17-Year Sentence in $12M Medicaid Fraud Case
July 31, 2025 | JacobiJournal.com – In a decisive legal ruling, the U.S. Court of Appeals for the Fourth Circuit upheld the 17-year prison sentence of Donald Booker, a North Carolina lab owner convicted of running a large-scale Medicaid fraud case. The court affirmed both the conviction and sentence tied to a scheme involving over $12 million in false Medicaid billing. Booker operated United Youth Care Services and United Diagnostic Laboratories, where he orchestrated the submission of fraudulent drug testing claims. The conspiracy involved kickbacks to treatment centers and housing facilities, including “Do It 4 The Hood” and “Legacy Housing,” in exchange for patient referrals. Scheme Involved Routine Drug Tests and Kickbacks According to court documents, Booker billed Medicaid for unnecessary, repetitive drug screens, often performed twice weekly on patients without proper medical evaluation. These patients were referred by community organizations that received direct illegal payments in return. The case resulted in convictions for illegal remuneration, money laundering, and conspiracy to defraud the U.S. government. Over $1.6 million in illegal kickbacks were proven at trial. The court rejected all arguments for reversal, stating the evidence overwhelmingly supported the jury’s findings. Broader Relevance for Medicaid Providers This Medicaid fraud case is part of a growing trend of federal enforcement targeting diagnostic labs, addiction treatment providers, and telehealth schemes. The Fourth Circuit’s ruling reinforces the DOJ’s approach of pursuing not only fraud but also financial arrangements that jeopardize patient care and program integrity. Providers nationwide are urged to evaluate referral relationships and billing protocols. This ruling serves as a strong compliance reminder in the face of mounting scrutiny. For a full legal opinion, see the Fourth Circuit’s document in the U.S. Court of Appeals for the Fourth Circuit (PDF). FAQ: About the Medicaid Fraud Case Why did the Fourth Circuit uphold the 17-year sentence in this Medicaid fraud case? The court found no error in the jury’s verdict or sentencing process, citing substantial evidence of illegal kickbacks, false claims, and intent to defraud Medicaid. What industries should take note of this ruling? Diagnostic laboratories, behavioral health providers, and referral networks—especially those serving Medicaid populations—should examine the ruling’s implications for compliance enforcement. What does this case mean for future Medicaid fraud investigations? The ruling signals continued judicial support for aggressive prosecution of healthcare fraud, including complex schemes involving community partnerships and repeated billing abuse. Stay ahead of the latest enforcement trends. Subscribe to JacobiJournal.com for weekly fraud, labor, and healthcare compliance updates impacting professionals nationwide. 🔎 Read More from JacobiJournal.com:
$14.6B Healthcare Fraud Sweep Expands with California Indictments
July 14, 2025 | JacobiJournal.com – $14.6B National Health Care Fraud Takedown Expands with California Defendants. The U.S. Department of Justice has announced additional charges tied to the ongoing $14.6B healthcare fraud takedown, now naming new California-based defendants. The updated enforcement sweep includes healthcare professionals, laboratory operators, and equipment suppliers accused of exploiting federal programs such as Medicare and Medicaid. California’s Expanding Role Federal prosecutors filed new indictments this week against multiple individuals in California. These latest charges span telehealth billing fraud, unnecessary genetic testing, opioid diversion, and DME kickback schemes. Many of the accused allegedly submitted false claims or used patient information to generate high-revenue services that were not medically justified. These developments bring the total charged nationwide to 324 individuals, with more than $7 billion in false billing across several enforcement districts. Nationwide Enforcement Results The takedown—first announced June 30—is now considered the largest coordinated health care fraud action in U.S. history. Federal agencies have already seized luxury assets, cryptocurrency wallets, and offshore accounts worth $245 million as part of ongoing asset recovery. The operation is jointly led by the DOJ, HHS-OIG, FBI, DEA, and state Medicaid Fraud Control Units, with support from CMS and local law enforcement. Why It Matters The $14.6 billion healthcare fraud takedown underscores ongoing and systemic vulnerabilities within the U.S. healthcare system, particularly in rapidly growing sectors such as telehealth, genetic testing, and durable medical equipment. Federal prosecutors warn that these fraud networks exploit gaps in oversight, billing systems, and patient data protections—resulting in massive financial losses to Medicare and Medicaid. More critically, these schemes put patients at serious risk. In many cases, individuals were subjected to unnecessary procedures, deceptive enrollment tactics, or billed for care they never received. This not only undermines clinical integrity but also erodes public confidence in legitimate medical services. The Department of Justice has indicated that the recent takedown is only the beginning. Investigations remain active, especially in high-risk jurisdictions such as California, Florida, and Texas, where coordinated criminal activity often intersects across multiple specialties. Additional charges, arrests, and forfeitures are anticipated as federal agencies continue dismantling complex fraud operations. For official details and ongoing updates, read the DOJ press release at justice.gov. FAQs: About the $14.6B Healthcare Fraud Takedown What is the $14.6B healthcare fraud takedown? The $14.6B healthcare fraud takedown is a nationwide enforcement action led by the U.S. Department of Justice targeting fraudulent schemes involving telehealth, genetic testing, opioid prescriptions, and durable medical equipment. It is considered the largest health care fraud crackdown in U.S. history. Why were California providers involved in the $14.6B healthcare fraud takedown? California defendants—ranging from physicians to lab operators—were charged for submitting false Medicare claims and laundering proceeds through shell entities. Their cases are part of the DOJ’s broader effort to dismantle organized fraud networks tied to the $14.6B healthcare fraud takedown. What does the $14.6B healthcare fraud takedown mean for Medicare oversight? The takedown signals stronger federal enforcement of Medicare compliance, especially in digital health and lab testing sectors. It shows increased scrutiny of billing practices to prevent misuse of public healthcare funds. Why is the $14.6B healthcare fraud takedown considered historic? This takedown is the largest coordinated healthcare fraud enforcement action in U.S. history, involving over $14.6 billion in fraudulent claims across telehealth, genetic testing, prescription drug distribution, and durable medical equipment. It highlights the scale and complexity of modern healthcare fraud and demonstrates the DOJ’s intensified focus on criminal networks that exploit public health programs. The operation also reflects strengthened partnerships between federal agencies such as HHS-OIG, FBI, and CMS to detect and prosecute systemic abuse. Stay informed on fraud enforcement trends and compliance updates. Subscribe to JacobiJournal.com for trusted healthcare reporting. 🔎 Read More from JacobiJournal.com:
National Health Care Fraud Takedown: California Defendants Charged in $14.6B Scam
July 4, 2025 | JacobiJournal.com – Federal authorities have charged 324 defendants in the 2025 National Health Care Fraud Takedown, exposing schemes worth over $14.6 billion. Among them, California healthcare fraud cases stood out, particularly in telemedicine, durable medical equipment (DME), lab testing, and opioid-related crimes. The Department of Justice confirmed that in the Northern District of California, five defendants face indictments for orchestrating Medicare fraud and illegal drug diversion schemes. These charges reflect California’s significant role in nationwide healthcare fraud trends, as the state remains a key focus for federal investigators due to its large healthcare market and history of complex fraud cases. According to the Office of Inspector General (OIG), these California-based schemes exploited vulnerable patient populations, fabricated billing for unnecessary or non-existent services, and contributed to the growing opioid crisis through illegal prescriptions. Authorities noted that advanced data analytics and inter-agency collaboration were pivotal in identifying these fraudulent networks. Federal prosecutors have emphasized that California healthcare fraud is not only a legal issue but a public health concern, draining critical resources from Medicare and Medicaid programs. As enforcement continues, healthcare providers and entities in the state are urged to strengthen compliance measures to avoid legal repercussions and safeguard public trust. Northern California’s Key Medicare Fraud Cases One notable defendant, Vincent Thayer of San Jose, is accused of submitting $68 million in fraudulent COVID-19 testing claims to Medicare, Medicaid, and the HRSA COVID-19 Uninsured Program. Authorities allege that Thayer exploited pandemic-era funding mechanisms, filing claims for tests that were either never performed or were medically unnecessary. This significant case underscores how California healthcare fraud schemes adapted quickly to capitalize on emergency federal funding intended for public health support during the pandemic. Another case involves Sevendik Huseynov of Sunnyvale, who is charged with using stolen identities to fraudulently bill Medicare Advantage for unnecessary durable medical equipment (DME). By manipulating patient information and fabricating needs for equipment like braces and orthotics, Huseynov allegedly siphoned millions from federal healthcare programs. These California healthcare fraud cases reveal how deeply fraudsters have infiltrated not only pandemic relief programs but also routine healthcare billing systems. The scale of deception reflects broader vulnerabilities in healthcare oversight, where swift adaptations by criminal networks can outpace regulatory safeguards. Federal officials stress that these prosecutions are part of an intensified crackdown aimed at deterring similar frauds and protecting the integrity of healthcare funding in California and nationwide. The Department of Justice, alongside the Department of Health and Human Services Office of Inspector General, continues to pursue those who exploit public health crises for personal gain. DOJ’s Data-Driven Fight Against California Healthcare Fraud Following this sweep, the DOJ’s Health Care Fraud Data Fusion Center is set to intensify efforts using AI and advanced data analytics to identify fraud patterns, particularly within California’s complex healthcare landscape. The state’s diverse and extensive healthcare infrastructure—spanning large hospital systems, telemedicine providers, and specialized care facilities—creates multiple entry points for bad actors. By leveraging predictive analytics, the DOJ aims to detect emerging California healthcare fraud trends before they escalate into billion-dollar losses. These technologies enable authorities to cross-reference billing anomalies, patient data, and provider networks in real-time, exposing schemes that would traditionally remain hidden for years. Officials emphasize that California’s high volume of healthcare transactions, combined with its leadership in digital health innovation, makes it both a target and a testbed for fraud detection initiatives. The ongoing collaboration between the DOJ, HHS Office of Inspector General, and California state agencies ensures that data-driven enforcement is tailored to the unique challenges posed by the state’s healthcare sector. Read the DOJ’s official press release on the takedown here. FAQs: About California Healthcare Fraud Takedown What is the National Health Care Fraud Takedown? The National Health Care Fraud Takedown is a coordinated federal effort by the DOJ and HHS to target large-scale healthcare fraud across the U.S., including cases of Medicare fraud, telemedicine scams, and drug diversion. How is California involved in healthcare fraud cases? California healthcare fraud cases often involve telemedicine billing schemes, DME fraud, and illegal drug diversion, with defendants exploiting federal healthcare programs like Medicare and Medicaid. What penalties do defendants face in California healthcare fraud cases? Defendants charged in California healthcare fraud cases face severe penalties, including significant prison time, hefty fines, and asset forfeiture if convicted of fraud, conspiracy, and related offenses. Stay Informed on Healthcare Fraud Enforcement. 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Telehealth CEO Convicted in $1B Medicare Fraud Case
June 27, 2025 | JacobiJournal.com – Telehealth Medicare fraud has taken center stage as the CEO of a telehealth software firm has been convicted in a billion-dollar healthcare fraud case. The conviction spotlights the dark side of digital medicine and the vulnerabilities within remote healthcare services. Prosecutors revealed that the executive orchestrated an expansive scheme that exploited Medicare billing through fraudulent prescriptions and medical orders—all disguised as legitimate virtual care. This case underscores the urgent need for stronger oversight in telehealth platforms to prevent further instances of telehealth Medicare fraud that jeopardize both patients and public funds. How the Telehealth Medicare Fraud Scheme Operated According to court documents and trial testimony, the company used its digital platform to generate false doctors’ orders and prescriptions. These included durable medical equipment and compound medications. The claims were submitted to Medicare and other federal programs as if they followed legitimate telehealth consultations, but they were part of an orchestrated telehealth Medicare fraud scheme designed to exploit billing loopholes. In truth, many patients had little to no interaction with a physician. In some cases, they were completely unaware that claims had been made in their name. This deception not only defrauded federal healthcare programs but also compromised patient data and trust, underscoring the broader risks that telehealth Medicare fraud poses to both individuals and the healthcare system at large. Targeting the Elderly The fraud relied on a nationwide network of call centers, marketers, and medical professionals who approved orders without proper review. Investigators found the scheme focused heavily on elderly Medicare beneficiaries. Deceptive tactics were used to enroll them in unnecessary treatment plans and billing cycles. As a result, Medicare paid out hundreds of millions of dollars before the fraud was detected. Uncovering the Scheme Authorities allege that the company submitted thousands of bogus claims for medical devices and prescriptions, many of which patients never requested or received. These claims appeared legitimate on paper, backed by fake telehealth consults and forged doctor approvals. Investigators say the scam targeted elderly beneficiaries, often without their knowledge. Why Telehealth Was Vulnerable The case raises serious concerns about how telehealth platforms, while convenient, can be misused. Rapid digital interactions made it easier for fraudulent claims to slip through, with billing systems ill-equipped to catch falsified consults in real time. This vulnerability created a perfect environment for telehealth Medicare fraud to thrive, as the absence of in-person verification allowed unscrupulous providers to manipulate the system without immediate detection. Moreover, the rapid expansion of telehealth during the pandemic outpaced the development of fraud prevention measures. As a result, many healthcare platforms lacked the robust compliance infrastructure necessary to identify patterns indicative of telehealth Medicare fraud. This gap in oversight is now prompting federal agencies and healthcare providers to reevaluate digital healthcare protocols to ensure stricter safeguards against such large-scale scams. A Warning to the Industry The executive’s conviction marks one of the largest healthcare fraud penalties linked to telehealth. While the technology itself isn’t to blame, the case highlights a deeper issue. Telehealth needs tighter compliance, stronger verification, and better oversight. This is especially urgent given the surge in telehealth Medicare fraud, which has exposed weaknesses in virtual care systems that were never designed to handle the scale of Medicare billing they now face. Industry leaders are being urged to collaborate with regulatory agencies to develop standardized protocols for telehealth services, including more stringent patient authentication and provider credentialing processes. Without proactive measures, the risk of telehealth Medicare fraud remains high, potentially undermining public trust in digital healthcare innovations. What It Means for Healthcare Providers As the use of telemedicine expands, healthcare professionals and vendors must implement stronger fraud controls. This case serves as a critical reminder: efficiency should never override ethical standards. Looking Ahead With sentencing set for later this year, federal agencies are signaling more scrutiny for telehealth firms. Compliance audits, provider vetting, and real-time billing review systems may become standard as regulators aim to prevent similar fraud on this scale. Digital care is here to stay—but integrity must stay with it. For official updates on Medicare fraud enforcement, visit the U.S. Department of Justice’s healthcare fraud page. FAQs About Fort Bend Hospice Healthcare Fraud What is the Fort Bend hospice healthcare fraud case about? The case involves hospice owners in Fort Bend County indicted for fraudulently enrolling non-terminally ill patients into hospice care, forging medical records, and submitting false claims totaling $87 million to Medicare and Medicaid. How does hospice fraud impact patients? Patients may be misclassified as terminally ill without their knowledge, limiting access to curative treatments and appropriate medical care. This can compromise patient safety and care quality. What penalties do the defendants face in the Fort Bend hospice healthcare fraud case? If convicted, the indicted hospice owners could face decades in federal prison, significant fines, and asset forfeiture under healthcare fraud and wire fraud statutes. Stay ahead of healthcare fraud developments. 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