What if I told you that cartels and other bad actors from around the world conspired to undermine the integrity of the health care system in the U.S. and came way too close to succeeding? If you didn’t hear about the bust of 324 people; the U.S.-based cartel shell medical supply companies; the pill mills pushing opioids; the doctors on the take; or how law enforcement captured many of the bad guys at the U.S. border and airports as they rushed to escape, that’s understandable. The feds revealed this potential $14.6 billion “depth charge” planted inside the Medicaid, Medicare, and private insurance programs in June, while most people were away on summer vacation.
Why did transnational organizations go after these particular programs? “Criminals go where the money is,” Acting Health and Human Services Inspector General,Juliet Hodgkins said at a news conference about “the largest health care fraud takedown in American history.” There’s more than $1.4 trillion spent by these government programs per year, and the bad guys have tried, by hook or by crook, and even with the aid of AI, to set into motion plans to steal nearly $15 billion. They got away with just shy of $3 billion before they were caught, and their other frauds were frozen in their tracks.
If this bust looks to you like it had Elon Musk’s old Department of Government Efficiency fingerprints on it, you’d be right. Using AI and law enforcement tactics, the DOGE team worked with HHS, the Center for Medicare and Medicaid, and an all-hands-on-deck array of federal agents from the DEA, FBI, and health care agencies to track down all fraud leads, according to Dr. Mehmet Oz, head of the Centers for Medicare and Medicaid Services (CMS). As a result, the feds are setting up a healthcare data fusion center to detect where fraud spikes are occurring in near real time.
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“DOGE is involved,” Oz told reporters in June. “The president has been very clear that he wants this fraud, waste and abuse crushed. That’s the word that’s used.” He continued, “DOGE is not just about cutting waste and fraud within government. [It] has been actively involved at CMS in helping us address places where fraud is existing that we never thought to look.”
Oz said these bad guys were sophisticated and used state-of-the-art methods to rip the government programs blind.
[T]hat’s how we’re being attacked now, and it’s not done by small-time operators, as you’re hearing about and you will read about. These are organized syndicates who are designing to hurt America. And why do they hurt our health care system? Well, CMS is probably the largest target of all, responsible for about $1.7 trillion dollars of disbursements. So, it’s a big target on our side. And they can pierce the veil of protection by just getting identifier numbers from our seniors or Medicaid recipients or others.
According to the DOJ, overseas cartel thieves set up a sophisticated network of medical supply companies that “submitted more than $10 billion in fraudulent healthcare claims to Medicare.” The bad guys used stolen identities of at least one million Americans found in data breaches and sold on the dark web to make the reimbursement requests. It’s unclear if the thieves used the unique Medicare and Medicaid identifying numbers to steal the money.
Other scams used a network of Phoenix-based sober living houses to demand government payments for people who never got addiction treatment at the facilities. The facilities, run by ProMD, received $560 million before the feds caught on to the scam.
In Atlanta, medical professionals ordered skin grafts for dying patients who didn’t need them. By the time the grift was discovered, they’d scammed Medicare out of $760 million.
People from as far away as Estonia have been arrested. Seven people were found trying to scuttle over the southern U.S. border but were stopped before they got away. Another bunch were caught trying to leave the country from U.S. airports.
The bad actors from Russia, Pakistan, and Eastern Europe used the American health care system like their “personal piggy bank,” the Department of Justice’s Acting Criminal Division leader, Matthew Galeotti, said. He said that “this was a staggering breach of trust” and they “will prosecute these criminals as aggressively as we would any drug dealer because that’s exactly what they are.”
Musk, who stepped away from the White House after a rift with President Donald Trump, is the one who conceived and executed the DOGE project, and he’s a damned American hero. Let’s give that guy a medal for saving American taxpayers yet another tranche of billions.
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