Federal prosecutors announced charges against hundreds of defendants in alleged Medicare, Medicaid, wound care, opioid, hospice, and behavioral health fraud schemes. Investigators credited advanced data analytics and coordinated enforcement efforts for identifying the cases.

A federal lawsuit claims hundreds of ineligible individuals were enrolled in Maryland-based health plans through an alleged scheme involving fraudulent residency information and referral networks.

Federal prosecutors allege a Houston-area clinic owner and co-conspirators submitted hundreds of millions of dollars in fraudulent Medicare and Tricare claims tied to medically unnecessary allograft procedures. Investigators say the scheme generated nearly $300 million in government payments and involved kickbacks and patient referrals.

Health insurers are investing in voice authentication, deepfake detection, and advanced analytics as criminals use AI-generated records, synthetic identities, and automated calls to exploit healthcare systems.

A Pennsylvania Supreme Court ruling found that the state's workers' compensation self-referral law does not apply to pharmacies, allowing physicians to refer injured workers to pharmacies in which they have a financial interest. The decision could fuel ongoing disputes over prescription drug costs and billing practices.

Federal prosecutors allege reality television personality and convicted crop insurance fraud defendant Steve McBee transferred valuable business interests to his sons while under investigation. The family disputes the claims and argues the transfers followed long-established trust practices.

Illinois has recorded 140 tornadoes in 2026, prompting the National Insurance Crime Bureau to warn residents about contractor fraud schemes that often emerge after major disasters. The alert comes as severe convective storm losses continue to generate tens of billions in insured claims annually.

A multi-year investigation uncovered organized criminal groups linked to staged collisions, vehicle financing fraud, and false insurance claims that generated millions in losses and drove up costs for insurers and policyholders.

As communities recover from tornadoes, floods, wildfires, and other disasters, NICB says contractor fraud schemes are becoming more sophisticated, with roofing scams, inflated mitigation claims, and assignment of benefits abuse among the most common threats.

New fraud data from Lloyds Bank and recent U.S. court rulings are increasing scrutiny of Meta's role in online scams, creating new questions about liability, insurance coverage, cyber risk, and potential subrogation opportunities.

New FICO report argues that fragmented data systems are leaving insurers vulnerable to organized fraud networks and calls for real-time, enterprise-wide fraud intelligence.

A federal appeals court found sufficient evidence that a Texas police chief conspired to burn his wife's SUV, report it stolen, and collect insurance proceeds. The case highlights multiple fraud indicators that claims investigators identified before any confession emerged.

Insurers are expanding their use of AI, telematics, digital identity verification, and predictive analytics as fraud schemes become more complex and costly across multiple lines of business.

Generative AI tools are making it easier to create fake claim evidence, while a new survey finds insurers have limited confidence in their ability to detect and prevent AI-driven fraud.

Louisiana investigators say four suspects made false statements tied to a 2025 crash involving a waste disposal truck. Authorities allege the fraudulent claims sought nearly $4 million in compensation.