Healthcare fraud isn’t only a financial crime, but there are many patients who are directly injured because of unnecessary procedures, fake diagnoses, or denied care. These families face serious consequences, which is why it’s major news when a takedown happens to combat healthcare fraud.
If you or a loved one has been affected by medical fraud, then you might choose to pursue a civil claim after the criminal case has been resolved. Our legal team at Wormington & Bollinger is always here to answer your questions and help you determine if you have a case worth pursuing.
What the 2026 DOJ Healthcare Fraud Takedown Uncovered
Recently, the Justice Department charged 455 people in a nationwide healthcare fraud crackdown, including 90 doctors and other medical professionals. This takedown adds up to more than $6.5 billion dollars in federal claims.
These cases were filed throughout the United States: 45 states and 56 federal districts. There was a massive participation among state Medicaid fraud units to help with the various cases. The schemes involved false billing for medical equipment, wound grafts, or therapy sessions that never actually happened.
Real harm happened in some of these cases, such as one medical practice that missed heart condition diagnoses, which eventually led to a patient’s death.
Among those medical professionals who have been charged is a nurse practitioner who used the proceeds for expensive jewelry and luxury cars, as well as a hospice owner who paid kickbacks to a funeral home employee for information about deceased Medicare beneficiaries.
How These Schemes Can Lead to Patient Harm
The harsh reality is that there are always victims when fraud occurs. If the medical providers are prioritizing billing over patient care, then the medical decisions that are made can be impacted.
For example, if unnecessary testing or insufficient testing is done, then it could result in a missed diagnosis or even a wrong treatment plan. Sometimes, patients are pushed into medications or procedures that they don’t actually need, which drastically increases the risk of side effects or complications.
In this series of healthcare fraud crackdowns that recently occurred, some of the charges involve a diversion of prescription opioids, which could potentially lead to addiction or overdose.
When Does Fraud Become a Medical Malpractice Claim?
One important thing that victims need to understand: just because there is a criminal case against a provider, it doesn’t automatically mean that harmed patients will be compensated. In fact, in order to receive the compensation that you deserve, it’s necessary to go through a separate civil process.
The basis of the malpractice claim will need to be established, which is why it’s essential to hire an expert legal team to assist with this process. For example, we can help by reviewing the medical records to see if there was a missed diagnosis, unnecessary surgery, or any other injuries that happened because of medical fraud. Then, we have a strong basis to move forward with a malpractice claim.
We offer thorough medical fraud investigative services, including a review of medical records, billing statements, and public indictment details to determine what actually happened during your treatment. Our legal team gathers the necessary evidence to prove liability and show that medical malpractice actually occurred and that you were injured by the provider’s mistakes.
Keep in mind that there are strict filing deadlines here in the State of Texas, so your best way forward is to contact a personal injury attorney as soon as possible.
Could You Be a Medicare Fraud Victim Without Realizing It?
Just because you had an unsatisfactory outcome with medical treatment, it doesn’t necessarily mean that you are a victim of Medicare fraud. There are several things that our legal team will look at to determine if you have a case worth pursuing.
Here are some of the things that you should watch for to determine if you or a loved one has been a victim of medical fraud:
- Review Medicare & Insurance Statements: Look through your Medicare statements and insurance documents, paying attention to the billing line-item details. You might notice charges that are tied to services you never actually received.
- Other Unusual Billing Activity: Medicare fraud could be occurring if you notice unexpected things on your invoices, such as a sudden change in providers, unfamiliar billing codes, or the healthcare providers are pressuring you into unnecessary testing.
- Known History of Medical Fraud: Have you recently visited a healthcare provider who is now connected to a medical fraud case? Then it’s time to request a full copy of your medical file to see if anything suspicious happened.
While government restitution is sometimes available for these medical fraud cases, it makes sense to consult with a personal injury attorney to determine if you have fraud-related injuries that qualify for additional compensation. Our team is here to answer your questions and offer personalized advice, ensuring that you receive the legal advocacy that you deserve.
FAQ
Is healthcare fraud the same thing as medical malpractice?
Keep in mind that there is a difference between healthcare fraud and medical malpractice. When fraud occurs, it is a financial crime that leverages government programs or insurance coverage. On the other hand, medical malpractice is a civil claim that can be pursued when you are harmed by a medical provider’s negligence.
Can I sue a doctor who was criminally charged with healthcare fraud?
Yes, if that doctor’s conduct led to your misdiagnosis or any other type of injury. In this situation, you might be able to pursue a civil claim, regardless of the outcome of the criminal case.
How do I find out if my provider was part of a fraud scheme?
You can search for announcements on the websites for the Justice Department and HHS Office of Inspector General. Look for your provider’s name. Or, another option is to request your records so they can be compared against the care you received.
Call the Legal Team You Can Trust: Wormington & Bollinger
If you believe that you’ve been hurt by a fraudulent healthcare provider, then you don’t have to walk this journey alone. Our team at Wormington & Bollinger is always just a phone call away and ready to review your case. Reach out for a no-obligation consultation to see if it makes sense to move forward with your claim. We will fight for the compensation that you deserve. Contact us today.