DOJ announces largest health care fraud takedown in American history

CHARLOTTE, N.C. — The Justice Department announced what it’s calling the largest health care fraud takedown in U.S. history on Monday, charging more than 300 people in connection with over $14 billion in alleged schemes. 

Here in the Carolinas, the alleged scams cheated taxpayers out of more than $20 million, according to state and federal prosecutors. Multiple agencies worked across state lines to uncover not one, but two separate fraud schemes operating in North Carolina and South Carolina. 

Nine people are now facing charges, accused of defrauding Medicaid programs of millions of dollars in the Carolinas. 

“Republican and Democrat, we’re all here with one goal and that is to eradicate health care fraud,” U.S. Attorney Russ Ferguson said. 

The larger case, dubbed “Operation Border War,” involves David Saunders of Charlotte and seven co-conspirators who allegedly stole over $21 million from South Carolina’s Medicaid program. State officials say the suspects targeted the most vulnerable patients. 

“The majority, nearly all of these were severely disabled children,” Attorney General Alan Wilson said. “Children who were quadriplegic or nonverbal or autistic, billing for services that these minor, severely disabled children never received.”

Investigators say the suspects created fake companies near the border, then filed fraudulent claims using stolen patient information. In some cases, they’re even accused of falsifying medical records for children who couldn’t speak. 

Then, in a separate North Carolina case, Crystal Jackson, a Charlotte resident, allegedly stole nearly $2 million by billing Medicaid for services to patients who were dead or in jail. 

“She held herself out as a licensed provider of health care. She was not,” Attorney General Jeff Jackson said. “She provided services to folks who were incarcerated or deceased, or at least claimed to.”

These cases are part of a national crackdown that charged 324 defendants with over $14 billion in health care fraud. The alleged $14.6 billion in fraud is more than twice the previous record in the Justice Department’s annual health care fraud crackdown. It includes nearly 190 federal cases and more than 90 state cases that have been charged or unsealed since June 9. Nearly 100 licensed medical professionals were charged, including 25 doctors, and the government reported $2.9 billion in actual losses.

Prosecutors say they won’t tolerate these types of criminals. 

“If you continue … defrauding the Medicaid system, you are going down,” Wilson said. 

The investigation isn’t over. The attorneys general say they’re looking at several other potential cases and encouraging anyone who suspects fraudulent behavior to report it. 

Contact Kayland Hagwood at khagwood@wcnc.com and follow her on Facebook, X and Instagram.