Contents
On October 22, 2026, DOJ announced charges in the Central District of California against 15 defendants, including six medical professionals. This page separates the matters inside that announcement, because the headline figure combines cases with different payers, defendants, charging instruments and stages. E18E19
The headline, read precisely
Charged, not adjudicated DOJ published two releases. The Central District of California release describes the actions as involving “$2 billion in fraudulent claims to government and private health care programs,” under a headline reading “$2 Billion in Losses Alleged”; the FBI director, quoted in it, refers to “$1.8 billion in losses,” and another official to “billions of dollars in intended losses.” DOJ’s national release describes “over $1.8 billion in fraudulent claims,” under a headline reading “Nearly $2 Billion in Loss.” Neither reconciles the figures. E18E19
Three things follow. The amounts are aggregates of distinct matters. Most of the total — more than $1.6 billion — comes from a single case billed to private insurers, not to Medicare or Medicaid. And every figure except one defendant’s plea is an allegation. The release itself states: “Indictments, complaints, and informations merely contain allegations. All defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.” E18
The matters
- Charged, not adjudicated
Substance-abuse treatment enterprise
More than $1.6 billion billed
Alleged patient recruitment and inducements, and sham treatment. E18
- Guilty plea
Related facility area manager
$199 million in claims he admitted assisting in submitting
The plea binds this defendant only. The figure overlaps the enterprise total and must not be added to it. E18
- Charged, not adjudicated
Arterial (atherectomy) procedures
About $134,955,000 submitted; at least about $54,817,000 paid
A cardiothoracic surgeon and a chiropractor; alleged unnecessary procedures, kickbacks and misidentified rendering providers. E20E21
- Charged, not adjudicated
Hospice (three schemes)
More than $138 million billed, per DOJ's total
Includes a hospice medical director charged over terminal-illness certifications. E18
- Charged, not adjudicated
Genetic-testing referral kickbacks
More than $4.2 million and more than $1.3 million in claims
Two physicians accused of accepting kickbacks to authorize testing orders. E18
- Charged, not adjudicated
Rehabilitation referral kickbacks
$150,000 to $250,000 in kickbacks alleged
Alleged payments for referring patients to a rehabilitation facility. E18
- Charged, not adjudicated
Medi-Cal pharmacy
About $269.1 million in claims; at least about $178.7 million paid
Alleged exploitation of suspended prior-authorization rules. E18
- Charged, not adjudicated
Prescription-drug samples
No billing figure given
Alleged prohibited sale of drug samples. E18
Figures are DOJ's descriptions of alleged conduct and are not additive. The plea is the only adjudicated outcome among these matters.
Individuals are described by role. The linked DOJ documents name the defendants.
The arterial-procedure indictment
Charged, not adjudicated The indictment in No. 2:26-cr-00668-JFW was returned October 20, 2026 and announced two days later. It charges a cardiothoracic surgeon and a chiropractor with four counts of healthcare fraud, and charges the chiropractor with two additional counts of bank fraud related to Paycheck Protection Program loan applications. E20E21
It alleges that two Los Angeles clinics performed medically unnecessary atherectomies — invasive procedures to remove plaque from arteries — or procedures not performed as represented; that patients were procured through kickbacks and bribes; and that claims misidentified the professional who performed the procedure. Paragraph 21(i), on page 7 of the PDF, alleges that from about January 2016 through August 2023 the clinics submitted approximately $134,955,000 in Medicare claims, “much of which” was for such procedures, and that Medicare paid at least approximately $54,817,000. E20
DOJ says data analytics identified the unusual billing. That explains how a case can begin; it does not supply the elements of a crime. The government must still prove the charged elements in court — including that specific procedures were unnecessary or misrepresented, who performed them, and intent. E18E20
How to read a charging document
- A complaint is a sworn statement supporting probable cause, often used to arrest quickly. An information is a charge filed by prosecutors without a grand jury, usually with the defendant’s agreement. An indictment is a charge returned by a grand jury. None is a finding of guilt.
- Billed, submitted, claimed, paid and lost are different numbers. A billed amount can be several times what a program paid; a paid amount is not automatically a loss if some services were legitimate.
- A related plea binds the person who entered it. It is evidence about that person’s conduct, not a verdict about anyone else’s.
- Aggregates are editorial. A takedown total adds figures across unrelated cases for a single announcement.
What Los Angeles does — and does not — tell us
Analytical inference The October 2026 actions illustrate the chain at its far end: patient recruitment and inducements at the start, unnecessary or misrepresented services in the middle, and claims to public and private payers at the end. They also show federal investigators using billing data to find outliers and then building cases from clinical records and money flows. E18
They do not establish anything about other providers who perform the same procedures, or about any Fresno organization. Operation Spinal Cap, the earlier Southern California prosecution in which a hospital owner pleaded guilty and was sentenced to 63 months, involved different procedures, payers and defendants. Resemblance supplies questions, not facts. E11
Reviewed and approved for publication by Kanwar Partap Singh Gill, MD.