Policy & oversight
DOJ Charges 15 in Los Angeles with 1.8 Billion Dollars in Health Care Fraud, Including Fake Medicare Hospice and Unnecessary Heart Procedures
Federal prosecutors unsealed charges on October 22 against 15 defendants for schemes that allegedly billed Medicare more than 272 million dollars for unnecessary atherectomies and hospice services provided to patients who did not qualify.
By the Goodsurance editorial teamOctober 23, 2026
The U.S. Department of Justice announced charges on October 22, 2026, against 15 defendants in the Los Angeles area, including six medical professionals, for health care fraud schemes alleged to total more than 1.8 billion dollars across government and private insurance programs.
Two of the three main fraud categories targeted Medicare directly. A cardiothoracic surgeon and a business partner who allegedly posed as a physician were charged with billing Medicare 134 million dollars for unnecessary atherectomy procedures, which are used to remove plaque from arteries. Prosecutors allege the partner identified patients and steered them toward the surgeries without medical justification.
15 charged in Los Angeles with 1.8 billion dollars in health care fraud, including fake Medicare hospice enrollments and medically unnecessary artery procedures.
Three separate hospice schemes generated more than 138 million dollars in allegedly fraudulent Medicare claims by enrolling patients who were not terminally ill, prosecutors said. One defendant, an 83-year-old physician, is accused of falsely certifying patient eligibility and generating more than 10 million dollars in improper bills.
A third scheme, described by the Justice Department as the largest substance abuse treatment fraud case it has ever prosecuted, involved billing more than 1.6 billion dollars to government and private programs for sham addiction treatment in Southern California.
Eight of the 15 defendants were arrested on October 22. All charges are allegations; none of the defendants have been convicted.
The Medicare hospice benefit is available to patients whose prognosis is six months or fewer if the illness runs its normal course. Entering hospice typically means forgoing curative treatment paid by Medicare, so fraudulent enrollments can affect patient care as well as program finances.
In plain words
On October 22, 2026, the Justice Department charged 15 people in Los Angeles with health care fraud. Six of them are doctors or other medical workers. Together, the cases involve more than 1.8 billion dollars in fake medical bills. Two parts of the case directly involve Medicare. First, a surgeon and his partner are accused of billing Medicare 134 million dollars for heart procedures that patients did not need. Second, three separate groups are accused of signing Medicare forms saying patients were dying so they could receive hospice care. The patients were not dying. Those false forms led to more than 138 million dollars in fake Medicare bills. A third part of the case involves 1.6 billion dollars in fake addiction treatment billed to government and private insurance programs. Eight people were arrested on October 22. These are charges, not convictions. No one has been found guilty yet.
Understand the basics first
Source: DOJ
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