This page collects the numbers that describe health care fraud in the United States: how much of total spending it is estimated to cost, what the Department of Justice charged in its national takedowns of 2024, 2025 and 2026, what False Claims Act cases recovered, how often Medicare and Medicaid pay claims they should not, and what HHS-OIG and the state Medicaid Fraud Control Units report each year.
Every figure links to the agency or organization that published it, and each table shows the year the data covers. Two cautions apply throughout. Takedown dollar figures are alleged losses in charged cases, and CMS improper payment rates measure payment errors, most of them documentation problems. CMS itself says they do not measure fraud.
How much health care fraud costs
No agency measures total fraud directly, because successful fraud is by definition undetected. The most quoted estimate comes from the National Health Care Anti-Fraud Association (NHCAA), a public-private group of insurers and law enforcement agencies.
| Statistic | Source | Year |
|---|---|---|
| A conservative estimate puts health care fraud at 3% of total US health care expenditures. | NHCAA, The challenge of health care fraud | 2018 spending baseline |
| Some government and law enforcement agencies estimate losses as high as 10% of annual health spending. | NHCAA, The challenge of health care fraud | 2018 spending baseline |
| At the 10% estimate, fraud could mean more than $300 billion a year. | NHCAA, The challenge of health care fraud | 2018 spending baseline |
| NHCAA describes the financial losses as "in the tens of billions of dollars each year". | NHCAA, The challenge of health care fraud | Ongoing |
The "3 to 10 percent" range that news coverage quotes comes from this page. The 3% figure is NHCAA's own conservative estimate; the 10% upper end is attributed to other government and law enforcement estimates. NHCAA's dollar figures use 2018 national spending of $3.6 trillion.
National health care fraud takedowns
Each year the Justice Department's Health Care Fraud Unit, US Attorneys' Offices, HHS-OIG, the FBI and the DEA announce a coordinated set of charges. The dollar figures are alleged amounts in charged cases; defendants are presumed innocent until proven guilty.
| Statistic | Source | Year |
|---|---|---|
| The 2026 takedown charged 455 defendants, including 90 doctors and other licensed medical professionals. | US Department of Justice, 2026 National Health Care Fraud Takedown | 2026 |
| The 2026 schemes involved over $6.5 billion in false claims, with cases in 56 federal districts. | US Department of Justice, 2026 National Health Care Fraud Takedown | 2026 |
| 50 state Medicaid Fraud Control Units took part in the 2026 takedown, the most in department history. | US Department of Justice, 2026 National Health Care Fraud Takedown | 2026 |
| CMS suspended 1,079 providers and revoked billing privileges for 1,403 as part of the 2026 action. | US Department of Justice, 2026 National Health Care Fraud Takedown | 2026 |
| In one 2026 wound care case, providers billed Medicare over $4 billion for one company's amniotic allografts, resulting in over $2 billion in payments. | US Department of Justice, 2026 National Health Care Fraud Takedown | Dec. 2021 to June 2024 |
| The 2025 takedown charged 324 defendants, including 96 licensed medical professionals, in schemes with over $14.6 billion in intended loss. | US Department of Justice, 2025 National Health Care Fraud Takedown | 2025 |
| The 2025 total more than doubled the prior record of $6 billion. | HHS-OIG, 2025 takedown summary | 2025 |
| Operation Gold Rush, part of the 2025 takedown, allegedly submitted $10.6 billion in fraudulent Medicare claims for urinary catheters and other equipment using the stolen identities of over 1 million Americans. | US Department of Justice, 2025 National Health Care Fraud Takedown | 2025 |
| HHS-OIG and CMS stopped all but about $41 million of the roughly $4.45 billion Medicare was scheduled to pay in the Gold Rush scheme. | US Department of Justice, 2025 National Health Care Fraud Takedown | 2025 |
| 49 defendants were charged in 2025 over more than $1.17 billion in alleged telemedicine and genetic testing fraud. | US Department of Justice, 2025 National Health Care Fraud Takedown | 2025 |
| 74 defendants were charged in 2025 over the alleged diversion of more than 15 million pills of opioids and other controlled substances. | US Department of Justice, 2025 National Health Care Fraud Takedown | 2025 |
| The 2024 enforcement action charged 193 defendants, including 76 licensed medical professionals, over about $2.75 billion in intended loss and $1.6 billion in actual loss. | US Department of Justice, 2024 National Health Care Fraud Enforcement Action | 2024 |
The 2025 total is dominated by one case: Gold Rush alone accounts for $10.6 billion of the $14.6 billion. That is why the 2026 headline figure ($6.5 billion) is lower even though more people were charged.
False Claims Act recoveries
The civil False Claims Act lets the government recover three times its losses plus a per-claim penalty, and lets whistleblowers (relators) file suits on its behalf. Health care has been the largest source of recoveries for years.
| Statistic | Source | Year |
|---|---|---|
| False Claims Act settlements and judgments exceeded $6.8 billion in fiscal 2025, the highest in the law's history. | US Department of Justice, FCA statistics FY2025 | FY2025 |
| Over $5.7 billion of the fiscal 2025 total related to matters involving the health care industry. | US Department of Justice, FCA statistics FY2025 | FY2025 |
| Whistleblowers filed 1,297 qui tam lawsuits in fiscal 2025, a single-year record, up from 980 in 2024. | US Department of Justice, FCA statistics FY2025 | FY2025 |
| The government opened 401 investigations of its own in fiscal 2025. | US Department of Justice, FCA statistics FY2025 | FY2025 |
| Settlements and judgments since 1986 now total more than $85 billion. | US Department of Justice, FCA statistics FY2025 | 1986 to 2025 |
| False Claims Act violators face three times the program's loss plus $11,000 per claim, and each billed item can count as a separate claim. | HHS-OIG, Fraud and abuse laws | Current |
The $5.7 billion counts federal losses only. The Justice Department notes that many of the same cases also recovered money for state Medicaid programs, which is not included. The record total also includes some large judgments still on appeal.
Medicare and Medicaid improper payments
CMS measures how often it pays a claim that should not have been paid, or paid the wrong amount. CMS states that improper payment measurement "is not a measure of fraud". Most errors are missing or insufficient documentation. The rates still show where money leaks.
| Statistic | Source | Year |
|---|---|---|
| Medicare fee-for-service had an estimated improper payment rate of 6.55%, or $28.83 billion. | CMS, FY2025 improper payments fact sheet | FY2025 |
| That is down from 7.66% ($31.70 billion) in fiscal 2024. | CMS, FY2025 improper payments fact sheet | FY2024 |
| Medicare Part C (Medicare Advantage) had a rate of 6.09%, or $23.67 billion, up from 5.61%. | CMS, FY2025 improper payments fact sheet | FY2025 |
| Medicare Part D had a rate of 4.00%, or $4.23 billion. | CMS, FY2025 improper payments fact sheet | FY2025 |
| Medicaid had a rate of 6.12%, or $37.39 billion, up from 5.09% ($31.10 billion) in fiscal 2024. | CMS, FY2025 improper payments fact sheet | FY2025 |
| 77.17% of Medicaid improper payments resulted from insufficient documentation. | CMS, FY2025 improper payments fact sheet | FY2025 |
| CHIP had a rate of 7.05%, or $1.37 billion. | CMS, FY2025 improper payments fact sheet | FY2025 |
Added together, the Medicare and Medicaid programs in this table account for about $94 billion in estimated improper payments in fiscal 2025. That figure covers every payment that failed review, paperwork errors included.
Oversight and enforcement results
HHS-OIG audits, evaluates and investigates HHS programs, and certifies and funds the state Medicaid Fraud Control Units (MFCUs) that prosecute Medicaid provider fraud and patient abuse.
| Statistic | Source | Year |
|---|---|---|
| HHS-OIG reports a total monetary impact of $19.04 billion for fiscal 2025. | HHS-OIG, About OIG fact sheet | FY2025 |
| HHS-OIG expects $12.70 in recoveries for every $1 it spends. | HHS-OIG, About OIG fact sheet | FY2025 |
| HHS-OIG excluded 2,837 individuals and entities from federal health programs and reported 1,577 criminal and civil actions in fiscal 2025. | HHS-OIG, About OIG fact sheet | FY2025 |
| Health risk assessments and linked chart reviews generated $7.5 billion in Medicare Advantage risk-adjusted payments, $4.2 billion of it from in-home assessments. | HHS-OIG, Spring 2025 semiannual report | 2023 data |
| In the six months to March 2025, OIG reported 744 civil and criminal actions and $3.51 billion in investigative receivables. | HHS-OIG, Spring 2025 semiannual report | Oct. 2024 to Mar. 2025 |
| The 53 Medicaid Fraud Control Units reported 1,185 convictions: 856 for fraud and 329 for patient abuse or neglect. | HHS-OIG, MFCU annual report FY2025 | FY2025 |
| MFCUs recovered almost $2 billion: $1.3 billion criminal and $706 million civil. | HHS-OIG, MFCU annual report FY2025 | FY2025 |
| MFCUs returned $4.64 for every $1 states and the federal government spent on them. | HHS-OIG, MFCU annual report FY2025 | FY2025 |
| MFCU convictions led to the exclusion of 900 individuals and entities. | HHS-OIG, MFCU annual report FY2025 | FY2025 |
What these numbers mean for healthcare providers and marketers
- Patient acquisition is an enforcement target. Recent takedowns name telemarketing campaigns, marketers paid per referral and stolen patient identities as the engine of the largest schemes. The Anti-Kickback Statute bars paying anything of value to induce referrals for services paid by federal health programs. Any marketing arrangement paid per patient for Medicare or Medicaid business deserves a compliance review before it starts.
- Documentation is where most money is lost. Over three quarters of Medicaid improper payments come from insufficient documentation. Accurate records protect revenue as much as they protect against audits.
- Behavioral health, hospice, wound care and equipment get the most scrutiny. These categories recur in every recent takedown. Providers in them should expect payer and regulator attention, and their marketing claims should match what they bill. See our addiction treatment statistics for the regulatory context in that field.
- Trust is part of how patients choose. Fraud headlines make patients more careful. Clear pricing, real reviews and accurate service pages help a legitimate practice stand apart; our guides on healthcare reputation management and patient privacy in marketing cover the practical side.
FAQ
How much does health care fraud cost each year?
There is no exact measure, because undetected fraud is not counted. The National Health Care Anti-Fraud Association estimates conservatively that fraud costs 3% of US health spending, and notes that some government and law enforcement estimates reach 10%, which could mean more than $300 billion a year.
Is the improper payment rate the same as the fraud rate?
No. CMS says improper payment measurement is not a measure of fraud. Most improper payments in fiscal 2025 came from missing or insufficient documentation. Some fraud shows up as improper payments, but the two numbers measure different things.
What was the largest health care fraud takedown?
By dollar value, the 2025 National Health Care Fraud Takedown, with over $14.6 billion in intended loss across 324 defendants. By number of defendants, the 2026 takedown was larger, with 455 people charged over more than $6.5 billion in false claims.
How much does the government recover from health care fraud?
In fiscal 2025, False Claims Act settlements and judgments involving health care exceeded $5.7 billion, out of a record $6.8 billion total. State Medicaid Fraud Control Units recovered almost $2 billion more, and HHS-OIG reported $19.04 billion in total monetary impact for the year.
What types of health care fraud are most common in recent cases?
Recent Justice Department takedowns highlight durable medical equipment billed with stolen identities, telemedicine and genetic testing schemes, amniotic wound graft billing, hospice and behavioral health billing for services not provided, and illegal diversion of opioids.
Sources and method
Figures were chosen from primary government sources wherever they exist: Justice Department press releases for takedowns and False Claims Act totals, the CMS improper payments fact sheet, and HHS-OIG fact sheets and reports. The fraud cost estimate comes from the National Health Care Anti-Fraud Association, the industry body most often cited for it. Fiscal years run October to September. Takedown dollar amounts are alleged losses in charged cases. Every figure and link was checked on 2026-10-08. For how patients look for care online, see our healthcare SEO statistics.
