Updated October 23, 2026
On October 22, 2026, the U.S. Attorney's Office for the Central District of California, the federal district that covers Long Beach and Downey, announced charges against 15 people, six of them medical professionals, in health care fraud cases it says add up to about $2 billion in false claims to Medicare, Medi-Cal, and private insurers. Eight were arrested that day. The cases include more than $1.6 billion billed for sham addiction treatment, which the Justice Department calls the largest case of its kind it has ever prosecuted; $134 million billed to Medicare for unnecessary artery procedures; more than $138 million across three hospice schemes for patients who were not terminally ill; kickbacks to doctors for genetic testing orders; and a Medi-Cal pharmacy case of about $270 million. (Source: the Central District's announcement of October 22, 2026.)
Announcements like this one are the end of investigations that ran for months or years, and they are rarely the end of the investigation. This guide covers who gets pulled into these cases, how they start, the federal and California statutes and what each carries, what a conviction means for a license and a career in health care, and what to do if agents have called, served a subpoena, or come to the office.
Who gets pulled into these cases
The headline defendants own the companies, but the cases are built around everyone whose name is on the paperwork. In this week's cases alone the government describes:
- Physicians and medical directors who signed orders, referrals, or certifications, including a hospice medical director charged over certificates of terminal illness for patients who had not chosen hospice.
- Nominee owners and managers. One defendant who has already pleaded guilty was a nominal owner and an "area manager" of several facilities.
- Marketers and recruiters, the people paid per patient. In one hospice case marketers were allegedly paid $1,500 to $1,800 per referral; in an addiction treatment case a recruiter was paid under a contract labeled "marketing services."
- Clinic staff who were told to coach patients, bill under other providers' names, or move patients into different insurance plans.
Billers, coders, office managers, nurses, and pharmacists are routinely interviewed in cases like these, sometimes as witnesses and sometimes as subjects, and the agents do not always say which. Being an employee who followed instructions is a fact that matters a great deal. It is not something to explain to an agent without a lawyer.
How these investigations start
Many start with data. Medicare and the HHS Office of Inspector General look for billing that sits far outside the norm: the artery case in this week's takedown was found because the surgeon was an extreme outlier nationally for that procedure, and the hospice cases point to patients being discharged alive at three to five times the national rate. Others start with patients who find out from Medicare or their own doctor that they were enrolled in something they never chose, with a former employee or a competitor, or with an insurer's special investigations unit.
The first sign is often not a criminal one: a records request or audit from Medicare or a private insurer, a payment suspension, a subpoena to the practice or its bank, a letter from the Medical Board or another licensing board, or a co-worker who mentions that an agent called. By the time agents knock, they usually have the claims data and the bank records already, and the interview is meant to fill in what the person knew.
The federal statutes, and what each one carries
A maximum is a ceiling set by Congress, not a prediction; in a federal fraud case the sentence is driven largely by the sentencing guidelines, where the loss amount is the biggest single factor, and by the person's role and history.
- Health care fraud, 18 U.S.C. § 1347. Knowingly and willfully executing a scheme to defraud any health care benefit program, public or private. Up to 10 years; up to 20 if the scheme results in serious bodily injury; up to life if it results in death. The government does not have to prove the person knew this particular statute existed, but it does have to prove the scheme was knowing and willful.
- Conspiracy, 18 U.S.C. § 1349. Agreeing with others to commit health care fraud or wire fraud carries the same maximum as the fraud itself. It is the charge that reaches people who never submitted a claim.
- The Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b). Paying, offering, soliciting, or receiving anything of value in return for referring patients or ordering services paid for by Medicare, Medi-Cal, or another federal program. A felony with up to 10 years and a $100,000 fine. Gift cards, free rides, groceries, and paying a patient's bills are all "anything of value."
- The Eliminating Kickbacks in Recovery Act, 18 U.S.C. § 220. The same idea for recovery homes, treatment facilities, and laboratories, and it reaches private insurance, not just government programs. Up to 10 years and a $200,000 fine for each occurrence. This is the statute behind the addiction treatment charges.
- False statements relating to health care matters, 18 U.S.C. § 1035. A materially false statement or document in connection with health care benefits: a chart note, a certification, a claim form. Up to five years.
- Wire fraud, money laundering, and bank fraud are routinely added when the money moved electronically, was moved again to hide it, or (as in one of this week's cases) went into a pandemic-era PPP loan application.
The general federal statute of limitations is five years from the offense (18 U.S.C. § 3282), but in a scheme or a conspiracy the clock usually runs from the last act, not the first.
California's own Medi-Cal fraud law
Medi-Cal cases can also be brought in state court by the Attorney General's Medi-Cal fraud division or the county District Attorney. Welfare and Institutions Code § 14107 covers false claims, false information to get paid more or to get an authorization, and schemes to defraud Medi-Cal, and it applies to billing agents as well as providers. It is punishable by county jail or state prison for two, three, or five years and a fine of up to three times the amount of the fraud. If a scheme causes or is likely to cause great bodily injury to two or more people, four more years can be added for each person injured. Private-insurance billing is charged under the insurance fraud statutes, mainly Penal Code § 550.
What a conviction does to a career in health care
For a licensed professional, prison exposure is only part of the risk. A conviction for a crime related to Medicare or Medi-Cal, or a felony health care fraud conviction, requires the Inspector General to exclude the person from every federal health care program for at least five years (42 U.S.C. § 1320a-7(a) and (c)(3)(B)). An excluded person cannot be paid, directly or through an employer, for anything those programs cover, which in practice ends most clinical jobs. Licensing boards act separately, and restitution and forfeiture can reach houses, cars, and accounts bought with the proceeds.
The same facts often support a civil case under the False Claims Act, sometimes filed by a former employee, and a licensing case at the same time. Anything said in one of those proceedings, an interview with an auditor, a deposition, a statement to the board, can become evidence in the criminal case. They have to be handled together, by someone who can see all three.
If agents call, a subpoena arrives, or they come to the office
Contact usually comes from the FBI, HHS-OIG, or the California Department of Justice. It may be a phone call, agents at home early in the morning, a grand jury subpoena for records, a search warrant executed at the clinic, or a target letter inviting the person to come in. Each one means the investigation is far along.
- Say that you want a lawyer, then stop talking. That ends the questioning, and it cannot be used against you. Lying to a federal agent is its own crime (18 U.S.C. § 1001), and the honest-but-nervous version of events given at the kitchen table is often what the case is later built on.
- Your employer's lawyer is not your lawyer. Counsel for a practice, hospice, or clinic represents the company. What you tell them can be handed to the government, and the company's interests and yours may split.
- Don't delete, edit, back-date, or "clean up" anything: charts, emails, texts, billing files, or phones. Altering records after an investigation starts turns a defensible case into an obstruction case.
- Don't consent to a search, and don't obstruct one. If agents have a warrant they will execute it; ask for a copy, and call a lawyer.
- Don't talk about the case with co-workers or the owners. Some of them may already be cooperating, and conversations can be recorded.
- Keep your own records of what you were told to do and by whom: emails, written policies, pay stubs, training materials. They show what an employee knew and when.
How these cases are defended
Health care fraud requires proof that the person acted knowingly and willfully, and that is where most of the work is. Whether a test, a procedure, or hospice care was medically necessary is a clinical judgment that qualified doctors disagree about, and charts read differently to an expert than to an auditor. What each person was told, what they signed and whether they read it, who wrote the policy, and who controlled the money are questions of fact, and they are often very different for a nurse or a biller than for an owner.
The kickback laws have exceptions, including for genuine employees paid for their work, and the details differ between the federal Anti-Kickback Statute and the recovery act. The loss figure, usually assembled by the government or the insurer, drives the sentencing guidelines and is often overstated by counting payments for services that were actually provided. And timing matters: before charges are filed there is sometimes an opportunity to present the person's side to the prosecutor, which closes once an indictment is returned.
Nothing here predicts an outcome. If you or someone in your family works in health care and has been contacted, the time to call is before the next conversation with an agent, an auditor, or the company's lawyer. A consultation with a white collar and federal criminal defense attorney in Long Beach or Downey covers the exposure, the license, and what to do this week.
This page is general information for Long Beach residents, not legal advice about any specific situation. Agency fees and procedures change; confirm details with the agency before you rely on them.
