Medicare Fraud Cases Making Headlines This Year

Medicare fraud continues to cost the U.S. healthcare system more than $100 billion annually, diverting funds intended for legitimate patient care and placing unnecessary financial strain on taxpayers.

These fraudulent activities range from billing for services never rendered to manipulating patient data for financial gain. The consequences affect not only federal budgets but also the quality and availability of healthcare for millions of beneficiaries.

This blog outlines the most significant Medicare fraud cases reported in 2025, highlights scams, and explains how you can protect yourself. 

What Is Medicare Fraud?

Medicare fraud involves the deliberate submission of false or misleading information to obtain unauthorized benefits from the Medicare program. It is a federal crime that undermines the integrity of healthcare delivery in the United States.

Common forms of Medicare fraud include billing for services not provided, misrepresenting diagnoses to justify unnecessary procedures, falsifying patient records, and using stolen Medicare numbers to submit false claims.

These activities are often carried out by individuals posing as providers and licensed professionals, exploiting system loopholes for financial gain. 

Many of these tactics overlap with broader health insurance scams that target private policies, employer plans, and government programs alike.

Unlike billing errors or documentation mistakes, Medicare fraud is intentional. It requires investigation and legal action and often leads to significant penalties, including fines, exclusion from federal programs, and imprisonment.

Top Medicare Fraud Cases of 2025

Medicare fraud in 2025 has taken many forms, ranging from corporate overbilling schemes to individual acts of corruption. 

Below are some of the most significant cases currently under investigation or resolved this year.

UnitedHealth Under DOJ Investigation

In February 2025, the Department of Justice launched a civil fraud investigation into UnitedHealthcare over allegations that the company inflated Medicare Advantage payments. 

The case centers on questionable diagnostic coding practices used to boost federal reimbursements. UnitedHealthcare denies any wrongdoing, but the probe signals increased scrutiny of large insurers.

$160 Million Fraud Scheme Conviction

In October 2024, Mohamad Mokbel, the owner of 4M Pharmaceuticals in Houston, was found guilty of running a major Medicare fraud scheme. He and his team submitted fake bills for expensive creams and medical equipment that patients didn’t actually need or use.

This went on for years and cost Medicare more than $160 million. The FBI, the Department of Health and Human Services, and other federal agencies investigated the case. Mokbel was convicted on 15 charges, including fraud and money laundering.

Optometrist’s Fraud and Corruption Case

Helen Zervas, an optometrist, pleaded guilty to charges of health care fraud and conspiracy to commit extortion. To conceal her actions, she submitted false Medicare claims and interfered with a state audit. 

Cases like this highlight how easily professional titles can be misused to gain trust and bypass scrutiny. If you receive a call from someone claiming to be a provider or Medicare representative, it’s smart to look up suspicious phone numbers before sharing any medical information.

South Texas Couple’s $14 Million Scheme

Jeremiah and Maria Luisa Yzaguirre set up a multi-million-dollar fraud by billing Medicare for wheelchair repairs that were never performed. Proceeds from the scheme were used to finance a luxury lifestyle, including high-end purchases and collectibles.

California Man’s $17 Million Hospice Fraud

Petros Fichidzhyan operated sham hospice companies and submitted fraudulent claims using stolen physician identities. He pleaded guilty to charges of health care fraud, identity theft, and money laundering. 

This case revealed how identity theft can support complex Medicare billing fraud. Similar schemes are often tied to hospice fraud and abuse that exploit end-of-life care systems for illegal profits.

In situations where names, licenses, or credentials are being misused, a reverse lookup tool can help you confirm legitimacy and prevent further exploitation.

Louisiana Nurse Practitioner’s $2 Million Fraud

Shanone Chatman-Ashley was convicted of ordering medically unnecessary durable medical equipment without conducting required patient evaluations. Her actions resulted in $2 million in fraudulent Medicare claims. Sentencing is pending. 

Gilead Sciences’ $202 Million Settlement

Gilead Sciences agreed to pay $202 million to settle claims that it gave illegal payments to doctors to encourage them to promote HIV medications. These actions led to higher Medicare and Medicaid bills than what should have been charged. 

Justice Department Sues Major Medicare Insurers

The DOJ has filed a lawsuit against several major insurers under the False Claims Act. The companies are accused of paying illegal incentives to brokers to enroll patients into specific Medicare Advantage plans while avoiding patients with costly disabilities. 

The case is ongoing and may set an example for future Medicare Advantage enforcement.

Medicare fraud doesn’t always look like a billing error. In some cases, it overlaps with emotional scams that target financial vulnerabilities, like this real story about a romance scammer exploiting a widow’s trust to access her life insurance.

Types of Medicare Fraud Schemes

Medicare fraud schemes target beneficiaries and the federal healthcare system. Below are four major types of fraud currently under investigation or public advisories.

Telemedicine Scams

In telemedicine fraud schemes, individuals posing as healthcare providers offer unsolicited telehealth services, often by phone or online. 

Their objective is to collect Medicare beneficiary numbers under the pretense of providing a virtual consultation or health screening. Once they obtain the beneficiary’s information, they submit fraudulent claims for services that were never provided.

Some scammers initiate fake video consultations to gather Medicare details. Before sharing personal information, here’s how to tell if a video call is real or fake.

Genetic Testing Scams

Scammers frequently target seniors with offers of “free” genetic tests, claiming the results can help detect cancer or other conditions. In reality, these tests are either medically unnecessary or never conducted. 

The primary goal is to collect Medicare identification numbers to bill the program for unapproved or fabricated services. These scams often result in unauthorized Medicare charges and can lead to identity theft, placing the beneficiary at risk for further fraud.

Many of these offers are also marketed to older adults. Learn how scammers target the elderly with medical lies and financial deception.

Durable Medical Equipment (DME) Fraud

DME fraud involves billing Medicare for medical equipment, such as braces, orthotics, or wheelchairs, that were either not provided or not medically necessary. In some cases, patient information is obtained without consent, and orders are placed without a valid physician’s prescription.

Electronic Funds Transfer (EFT) Fraud

EFT fraud targets the Medicare payment system directly. Fraudsters submit unauthorized requests to redirect electronic payments intended for legitimate healthcare providers. These changes are often made using forged documents or compromised provider credentials.

This redirection of funds often happens without the provider’s knowledge. You can stay ahead of these tactics by understanding the state of online scams in 2024.

How to Protect Yourself from Medicare Fraud?

Preventing Medicare fraud requires proactive steps and attention to detail. The following measures can help beneficiaries and their families reduce their risk of exploitation:

Protect Your Medicare Number

Keep your Medicare number private and share it only with verified medical professionals. Do not give it out in response to unsolicited phone calls, emails, or home visits.

Be Wary of Unsolicited Offers

Decline offers for “free” genetic tests, medical equipment, or health screenings that require your Medicare information. Many Medicare scam calls are disguised as routine follow-ups. Learn how to identify and report scam calls.

Review Your Medicare Statements

Examine all Medicare Summary Notices (MSNs) and Explanation of Benefits (EOBs) carefully. Report any unfamiliar services, billing errors, or duplicate charges.

Confirm the Legitimacy of Providers

Verify that any healthcare provider or medical supplier is properly enrolled in Medicare. Use official resources like Medicare.gov or call 1-800-MEDICARE to confirm enrollment status.

Report Suspected Fraud

If you believe Medicare fraud has occurred, contact the Office of Inspector General at 1-800-HHS-TIPS or submit a report online. You can also search someone’s profile using their picture to uncover hidden accounts or prior complaints.

Consult a Search Specialist

In cases where you’re uncertain about the identity of someone contacting you about Medicare services or benefits, a trained search specialist can help investigate. 

Social Catfish connects individuals with experts who specialize in verifying identities, uncovering digital footprints, and detecting fraudulent activity. This can be especially helpful when dealing with complex scams or when traditional reporting channels haven’t provided answers.