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Health Care Fraud Unit

The Fraud Section’s Health Care Fraud Unit is comprised of over 80 experienced white-collar prosecutors, who focus solely on prosecuting the nation’s most complex health care fraud matters as well as medical professionals involved in the illegal prescribing and dispensing of opioids and other controlled substances. The Unit’s core mission is to protect the public fisc, involving health care benefit programs such as Medicare, Medicaid, and TRICARE, and to protect patients from egregious fraudulent schemes that result in patient harm, including the overprescribing of controlled substances.  The Unit routinely prosecutes defendants who orchestrate schemes that result in the loss of hundreds of millions of dollars, the distribution of thousands of controlled substance pills, and complex money laundering, tax, and other associated financial crime offenses. 

The Health Care Fraud Unit is a leader in using advanced data analytics and algorithmic methods to identify newly emerging health care fraud schemes and to target the most egregious fraudsters.  The Unit’s team of dedicated data analysts work with prosecutors to identify, investigate, and prosecute cases using data analytics.  This novel approach has led to some of the Fraud Section’s largest cases and initiatives.   

The Health Care Fraud Unit employs a recognized and successful Strike Force Model for effectively and efficiently prosecuting health care fraud and illegal prescription cases across the United States.  Unit prosecutors currently operate in nine Strike Forces across the country. The Strike Force Model centers on a cross-agency collaborative approach, bringing together the investigative and analytical resources of the Fraud Section, Federal Bureau of Investigation, U.S. Department of Health and Human Services-Office of the Inspector General, Centers for Medicare & Medicaid Services, Drug Enforcement Administration, Defense Criminal Investigative Service, Federal Deposit Insurance Corporation-Office of the Inspector General, Internal Revenue Service-Criminal Investigations, Department of Labor-Office of the Inspector General, United States Postal Service-Office of the Inspector General, Veterans Administration-Office of the Inspector General, and other agencies.  

The Health Care Fraud Unit conducts the most trials of any Department of Justice component.  Its prosecutors are known for conducting the largest and most complex health care fraud trials in districts located across the country.  

Health Care Fraud - Strike Force map

 

Points of Contact to Report Health Care Fraud:

Health and Human Services Office of Inspector General (“HHS-OIG”): HHS-OIG fights waste, fraud, and abuse, and works to improve the efficiency of Medicare, Medicaid, and more than 100 other HHS programs.  HHS-OIG oversees Medicare and Medicaid.  The OIG Hotline accepts tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement in HHS programs.  Click HERE for more information about the HHS-OIG hotline.

  • Make an online complaint HERE
  • Call the tip hotline at 800-HHS-TIPS

Federal Bureau of Investigation (“FBI”), White-Collar Crime: The FBI’s white-collar crime program focuses on analyzing intelligence and solving complex investigations—often with a connection to organized crime activities.  The FBI is the primary agency for investigating health care fraud, for both federal and private insurance programs. 

  • Make an online complaint HERE
  • Call the tip hotline at 800-CALL-FBI

Drug Enforcement Administration (“DEA”), Diversion Control Division: DEA’s Diversion Control Division prevents, detects, and investigates the diversion of controlled pharmaceuticals and listed chemicals from legitimate sources while ensuring an adequate and uninterrupted supply for legitimate medical, commercial, and scientific needs.

  • Make an online complaint HERE
  • To report illegal prescription drug sales or suspicious pharmacies make an online complaint HERE
  • Call the tip hotline at 877-792-2873

 

Contact Us Regarding Health Care Fraud:

By Mail

Fraud Section, Criminal Division
U.S. Department of Justice
ATTN: Chief, Health Care Fraud Unit
950 Constitution Ave., NW
Washington, DC 20530

By E-Mail

Report a health care fraud violation via e-mail to HCF.tips@usdoj.gov.

 

Updated February 16, 2024