Investigators at the Department of Health and Human Services produced 622 criminal actions and 861 civil actions against health care fraud in fiscal 2025, the department’s Office of Inspector General said Wednesday. The counts, published in an annual fact sheet on the Health Care Fraud and Abuse Control Program, describe what the inspector general’s own investigations led to between October 2024 and September 2025.
Keeping a Medicare number out of the next case
Many of the schemes behind such numbers run on someone else’s identity. A stolen Medicare number can be used to bill for equipment, tests or visits that never took place, and the person whose number was used often learns of it only from a statement or a collection letter. Anyone who spots a provider never visited, or a supply order that never arrived, can report it directly to the inspector general’s complaint page, which costs nothing.
The office asks complainants to bring names and contact details of the businesses involved, a short account of what happened and when, and any records such as billing statements or emails. It also warns that not every complaint leads to an investigation, and that it rarely steps in to win back an individual’s money, so a personal refund usually has to be pursued through other channels.
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What an action is, and what it is not
The fact sheet says HHS-OIG investigations “resulted in” the 622 criminal and 861 civil actions. It does not define the word action beyond that. On the civil side it says the category includes false claims cases, unjust enrichment cases and civil monetary penalty settlements, so the 861 is a mix of resolutions rather than a count of lawsuits filed or defendants named.
The criminal figure is likewise a count of actions, not of people. One action can involve several defendants, and the sheet does not say how many people stand behind the 622. It also covers only what the inspector general’s office investigated, so it is not a tally of every health care fraud case in the country.
Which agencies bring the cases?
Two federal bodies carry most of the load, and the sheet credits each with different pieces. HHS-OIG investigates, produces the criminal and civil actions counted above, and decides who is barred from federal programs. The Justice Department, through its U.S. Attorney’s Offices, decides on charges and reports the case and conviction numbers.
Those Justice Department numbers sit beside the OIG counts in the same document. The department opened at least 741 new criminal health care fraud investigations in fiscal 2025, filed charges in at least 382 criminal cases involving at least 601 defendants, and counted at least 448 defendants convicted. The FBI’s work, the sheet says, disrupted at least 356 criminal fraud organizations and dismantled at least 79 enterprises.
The exclusion list
Outside the courtroom, the inspector general’s office also holds an administrative power. It excluded 2,837 individuals and entities from Medicare, Medicaid and other federal health care programs in fiscal 2025. An excluded provider cannot bill those programs, which removes the revenue stream that made the alleged scheme worth running.
Exclusion does not require a courtroom win in every case, and it can follow a conviction, a civil settlement or a license action. The sheet does not break the 2,837 down by reason, so the share tied to the 622 criminal actions is not known from this document.
What the counts do not show
The figures are volume, not dollars. The fact sheet reports the money side separately, including more than $6.9 billion in civil False Claims Act settlements and judgments for the year, and it cautions that its criminal totals may leave out matters handled only by the Justice Department’s Criminal Division Fraud Section. It adds that numbers may differ across reports because agencies count in different ways.
For a Medicare enrollee, the practical reading is that enforcement is large and active, but it works after the fact. Cases are built from billing patterns, tips and records that surface months or years later, and by then a stolen number may already have been used.
Is the Medicare number locked down like a bank card?
The cases above start with a number a thief should never have had. A Medicare number is only one door, and a thief holding it often looks next for bank logins, credit files and tax accounts, where the losses can be far larger than a single bad claim.
That turn, from a Medicare fraud case to the accounts around it, is what Scam-Proof Your Accounts in a Weekend covers. It lays out ten moves in weekend order, including how to freeze your credit at all three bureaus, free by federal law, and how to lock your bank logins with two-step login, alerts and a verbal password, so one leaked number does not become an emptied account.
Lock the Medicare number’s neighbors with the credit-freeze and bank-login checklist →
This article was produced with AI assistance and edited for accuracy against the sources linked above.
Warren Cohen is a finance writer based in Phoenix, Arizona, covering personal finance topics including credit, banking, and beginner investing. He earned his degree in business administration from Arizona State University and began his career working in consumer finance, where he gained direct experience with lending and credit systems. He now writes for personal finance websites and fintech platforms, focusing on clear, practical content that helps readers make informed financial decisions.
