As we move through 2025, the pace of fraud, waste, and abuse (FWA) schemes in healthcare show no signs of slowing. This past quarter brought cases involving unlicensed clinics, hospice kickbacks, insider deception, and prescription fraud totaling billions in false claims. Read our breakdown of 10 major healthcare FWA schemes from April through June 2025—and what they reveal about the evolving tactics of bad actors.

Scheme to impersonate a health facility: $2.5 billion

Authorities discovered an unlicensed addiction treatment facility operating out of a Phoenix motel with no running water, which cost the state $2.5 billion in alleged fraudulent activities. The setup was linked to a clinic already suspended by the Arizona Health Care Cost Containment System (AHCCCS), the state’s Medicaid program. Charges included billing for services never provided and billing for deceased patients. The facility is accused of targeting vulnerable populations, a majority of them Native Americans.

Prescription fraud: $270 million

A Southern California man was charged for his role in a $270 million Medi-Cal prescription drug reimbursement scheme. Authorities say he and alleged co-conspirators submitted fraudulent claims for medications that were not medically necessary and, in some cases, never dispensed, taking advantage of a temporary pause in prior authorization rules. They allegedly received over $178 million in reimbursements and used kickbacks and money laundering to hide the activity.

Hospice fraud $87 million

Three women in Fort Bend County, Texas were indicted in an $87 million hospice fraud case. They allegedly conspired to fraudulently enroll elderly patients in hospice care without terminal diagnoses. The women would allegedly deliver things such as adult diapers and bill the government as if they were providing hospice care.

DME and prescription fraud: $65 million

Four Florida residents were indicted for orchestrating a $65 million Medicare fraud scheme involving kickbacks and medically unnecessary durable medical equipment (DME), specifically various types of orthotic braces. The scheme involved coordinating with telemedicine providers and marketers to funnel claims through multiple shell companies.

Neurofeedback therapy scheme: $15 million

A Minnesota couple was indicted in a $15 million fraud scheme. They allegedly repetitively over-billed for neurofeedback therapy with inappropriate codes. The alleged fraudulent billing spanned years and included misrepresentation to federal health programs even after several warnings.

Lab testing fraud: $15 million

A South Carolina man was charged in a fraud scheme involving unnecessary testing and Medicare billing, allegedly totaling over $15 million. He is said to have offered senior nursing home patients COVID-19 testing and then submitted fraudulent claims for respiratory pathogen panel (RPP) tests through multiple labs. As alleged, these RPP tests were medically unnecessary, were never ordered by a treating physician as required, and many were never actually performed, including for patients who had died.

Medical transportation service scheme: $5 million

The final suspect in a $5 million Medicaid fraud case was arrested at Orlando International Airport. The ring allegedly ran a nonemergency medical transportation service, fraudulently billing Medicaid for thousands of nonexistent trips and inflated mileage. In 2023, 20 co-defendants were previously arrested.

Telehealth fraud: $111,000

A Miami psychotherapist, previously convicted in a $70 million Medicare fraud, was indicted again after billing more than $111,000 in Medicaid claims for psychotherapy services despite being barred from federal health programs. Federal prosecutors allege he continued seeing patients via telehealth in New Hampshire and even involved a patient in drafting a presidential pardon application. The indictment includes eight new counts of healthcare fraud.

Insider fraud: $100,000

A San Jose woman, formerly an anti-fraud expert and senior manager at a fortune 500 tech company, was charged with defrauding her employer’s health plan out of more than $100,000. She allegedly submitted 167 false claims for medical services—many of which never occurred—using forged documentation and duplicate submissions.

Skin graft fraud

Two men were charged in healthcare fraud scheme involving false claims to Medicare. Allegedly, one man who was a licensed healthcare provider would submit claims to Medicare and Medi-Cal while the other man, who was not licensed, was the one who actually rendered the skin graft services to beneficiaries. The case is said to have involved forged documents and illegal kickbacks.

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By applying a proactive, data-driven review process, Cotiviti helps payers stay ahead of FWA trends and protect their members’ plan benefits. Learn how our 360 Pattern Review™ solution combines the power of prepay FWA identification with postpay investigation to reduce errors while supporting provider education and preserving relationships.