Strengthening Safeguards Against Medicare and Medicaid Fraud
The U.S. Treasury Department has issued an advisory urging financial institutions to strengthen safeguards against emerging fraud schemes targeting Medicare and Medicaid. This announcement by the Financial Crimes Enforcement Network (FinCEN) emphasizes the need to combat financial fraud associated with healthcare programs. The call to action coincides with a significant rise, approximately 20%, in suspicious activity reports related to the healthcare sector from 2024 to 2025.
FinCEN's advisory identifies common fraudulent activities, such as false reimbursement claims for medical services not rendered, substandard, or unnecessary. Complex criminal organizations often leverage foreign nationals as nominal owners of healthcare entities to conduct these scams, unlawfully acquiring personal and beneficiary information for false billing activities. Such schemes frequently involve kickbacks and bribery with the assistance of complicit professionals.
Highlighting the fight against healthcare fraud as critical to national anti-money laundering and anti-terrorism financing strategies, the advisory supports Executive Order 14249 to protect federal payments. Collaboration with the FBI and the Health and Human Services' Office of Inspector General has been essential in framing this advisory. Additionally, FinCEN has proposed a rule to reward whistleblowers financially for actionable intelligence on financial crimes, with potential earnings of 10% to 30% of collected penalties under relevant acts.
FinCEN has also introduced an online portal for confidential whistleblower submissions. Public reporting of healthcare fraud can be directed to the Department of Health and Human Services Office of Inspector General, while cyber fraud incidents are reportable to the FBI's Internet Crime Complaint Center or local FBI offices. For comprehensive information, individuals can contact FinCEN's Regulatory Support Section, with complete documentation available online under FIN-2026-A001.