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On 26 Jun 2025, [email protected] (Bradley K. Sherman) posted some news:103k8jb$i7h$[email protected]:

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Gerald Quindry was facing a quandary. The 73-year-old retired engineer
received a statement last year that Medicare, his health insurance
provider, had been billed $15,500 for urinary catheters — but his doctor
had never ordered them, and Quindry never wanted nor received them.
Quindry complained to Medicare. But he said the representatives seemed nonplussed by his complaint, and he could find little information about
the incident himself beyond news reports of catheter-related fraud in the government program.

“Obviously, somebody deserves to be in jail,” Quindry told The Washington Post in February.

Four months later, several people are — and they are facing criminal
charges in what the government says is the largest health care fraud bust
in U.S. history.

Quindry was one of more than 1 million Americans whose personal
information was compromised in an alleged $10.6 billion fraud scheme, the details of which were unsealed last week and announced by federal
officials Monday.

The two-year investigation, dubbed Operation Gold Rush, uncovered a
conspiracy to purchase more than 30 small health care supply companies
that were already enrolled with Medicare, officials said. Conspirators
then used those companies to submit a flood of claims for urinary
catheters, continuous glucose monitors and other supplies that were not medically necessary, law enforcement officials allege.

The numbers were often eye-popping. Beginning in late 2022, the companies collectively submitted fraudulent claims to Medicare for more than 1
billion urinary catheters, officials said.

“I don’t even know if [the United States] has the ability to manufacture 1 billion catheters in such a short time,” said Isaac Bledsoe, director of strategic projects and initiatives at the Department of Health and Human Services’ inspector general’s office, which helped lead the investigation along with the Justice Department and the FBI. “The absurdity, the
brazenness of these actors is really just astounding.”

Federal officials were able to prevent more than 99 percent of the
Medicare payments from reaching the alleged perpetrators, saying that
teams at the Centers for Medicare and Medicaid Services and the HHS
inspector general’s office moved quickly to identify fraudulent bills, suspend payments to the suspected companies and partner with other federal agencies that launched Operation Gold Rush in early 2023. They also said
they had been able to seize tens of millions of dollars in fraud proceeds. Bledsoe said it showed how the federal government has moved from its long- standing “pay and chase” approach — where agencies would pay out claims before identifying fraud and then try to claw the money back — to a “stop and caught” model.

But the perpetrators, authorities allege, were still able to collect about
$1 billion in payments from other insurance companies that help cover
older Americans’ health care costs, known as Medicare supplemental
insurers. Those insurers were contractually obligated to reimburse claims processed by Medicare — even if Medicare didn’t end up paying out the claims, officials said. For instance, Quindry said his supplemental
insurance company, Blue Cross Blue Shield of Illinois, paid 20 percent of
his fraudulent $15,500 bill.

Federal officials Monday also announced that they had disrupted other
alleged health care fraud schemes potentially worth $4 billion in total, including some focused on telemedicine, genetic testing and opioid
trafficking, as part of an ongoing government initiative aimed at health
care fraud.

“These criminals didn’t just steal someone else’s money. They stole from you,” Matthew R. Galeotti, head of the Justice Department’s criminal division, said at Monday’s news conference, where he was flanked by CMS Administrator Mehmet Oz and other federal officials.

Nineteen people have been charged with helping coordinate the Operation
Gold Rush scheme, according to indictments unsealed last week in federal
court in New York, Illinois and other states. The alleged conspirators —
who include people from Estonia, Kazakhstan and Russia — face charges of conspiracy, health care fraud and money laundering that could send them to prison for years. At least one has taken a plea deal, according to public
court dockets.

Seven alleged conspirators were intercepted at U.S. airport departure
gates and at the U.S. border with Mexico, officials said, while others
have fled the U.S. Four defendants were apprehended in Estonia as a result
of cooperation with Estonian law enforcement, officials said.

The Post last year first revealed the federal investigation.

Gabriel L. Imperato, a partner with the Nelson Mullins law firm and a
former HHS lawyer, said Medicare supplies have long been a target for
overseas health care fraud rings, which have often deployed similar
tactics in hopes of tapping the sprawling, multibillion-dollar market.

“It’s just an opportunity for international criminals,” Imperato said, adding that fraudsters have used similar tactics for decades. “It’s a never-ending quest to try to get beyond the whack-a-mole phenomena.”

Officials said the episode underscores the vulnerabilities in the American health care system and the complexity of cracking down on waste, fraud and abuse — a vowed political priority of the Trump administration. The U.S.
DOGE Service and its former leader, Elon Musk, repeatedly highlighted the
risk of Medicare fraud this year, although with sometimes misleading or
false claims.

The episode also resulted in mass confusion for patients across the
country. Medicare and its contractors received more than 400,000
complaints related to the catheter scheme, federal officials said, with
older Americans demanding to know why their Medicare accounts had been
billed by companies such as Pretty in Pink and Mainstreet DME.

The scheme ensnared more than 7,000 physicians, whose identities were used
to order medical supplies without their knowledge, according to officials.
It enmeshed legitimate companies that happened to share the same name as
the alleged perpetrators, such as the Pretty In Pink Boutique in
Tennessee, an unrelated cancer supply store that was so drowned by
complaints, it posted instructions on how to report insurance fraud.

It frustrated accountable-care organizations — groups of hospitals and physicians that receive federal incentives to deliver high-quality, low-
cost health care — which worried that they could collectively lose
millions of dollars in payments because it appeared that they were failing
to manage their patients’ health care spending. The National Association
of ACOs, an industry trade group, publicized the alleged fraud last year.
The CMS subsequently issued a rule to change how it paid for catheters and effectively protect the accountable-care organizations from the spike in catheter bills.

And the scheme angered lawmakers, who demanded answers on why the alleged
fraud had gone publicly unreported for more than a year.

https://www.washingtonpost.com/health/2025/06/30/health-care-fraud-bust- largest-in-us-history/

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