What Healthcare Compliance Professionals Can Learn from the 2025 Healthcare Takedown

On June 30, 2025, the Department of Justice (DOJ), the Department of Health and Human Services Office of Inspector General (HHS-OIG), and state and federal partners announced the results of the 2025 National Healthcare Fraud Takedown—a sweeping enforcement action resulting in charges against 324 defendants across across 50 federal districts and 12 State Attorneys General’s Offices, linked to over $14.6 billion in fraudulent billings to Federal healthcare programs. Beyond the headlines, this takedown offers valuable lessons for compliance professionals tasked with protecting their organizations. Here are three key insights.

1. Telemedicine and Genetic Testing Are Still Under the Microscope

Telehealth-related fraud remains a top enforcement priority. Over $1.17 billion of the alleged fraud in this year’s takedown stemmed from schemes involving telemedicine-generated orders for medically unnecessary genetic tests, DME, or prescriptions.

Compliance Takeaway:

·       Ensure genuine provider-patient relationships exist

·       Vet partners for medical appropriateness

·       Monitor ordering patterns for high-reimbursement services

·       Conduct periodic audits of telehealth consults and billing

2. Vulnerable Populations Remain Targets for Exploitation

Another major element in this year’s takedown involved unnecessary wound care services provided to elderly patient – many of whom were in hospice care. While fraud schemes targeting vulnerable populations aren't new, they are persistent and ever-evolving.

Compliance Takeaway:

·       Scrutinize home health and post-acute services for appropriateness

·       Confirm referrals and treatments are medically supported

·       Watch for overutilization or repetitive care to the same patients

·       Increase oversight and education in high-risk populations or facilities

3. Use Data Analytics Like Law Enforcement Does

DOJ and HHS-OIG increasingly rely on data analytics to detect billing anomalies and outlier behavior. The 2025 takedown used these tools to identify suspects and support investigations.

Compliance Takeaway:

·       Benchmark provider data across specialties and regions

·       Review utilization for high-risk services like wound care or genetic tests

·       Monitor for outlier billing patterns and modifier usage

·       Use pre- and post-payment audits to detect issues early

Final Thoughts: Elevate, Audit, and Act

The 2025 Healthcare Fraud Takedown should motivate compliance teams to elevate their programs, audit proactively, and act decisively. You don’t need to predict every enforcement trend, but you do need to:

·       Monitor patterns of enforcement

·       Use internal data analytics

·       Focus on vulnerable populations and services

·       Educate clinicians and administrators about evolving risks

Fraud schemes are evolving—but so can your compliance program.