政府效率部发布多年匿名开源医疗补助数据,前DOGE负责人埃隆·马斯克称这是透明度的胜利,将使欺诈“易于发现”


但对司法部而言,将网络侦探工作转化为起诉可能会困难得多——而且在法律上也会很复杂。

检察官和隐私专家警告称,从匿名举报到法庭案件的飞跃将面临三个障碍:患者隐私、证据标准以及各州报告的医疗补助数据质量参差不齐。

根据卫生与公众服务部的数据,DOGE发布的数据将包含有关医疗服务提供者、索赔和其他一般信息的汇总级信息。特朗普政府高级官员强调,任何发布的信息都将按照联邦隐私法进行,以避免识别个人或分享私人医疗信息。

此次数据发布正值司法部加强医疗保健欺诈执法力度,尤其针对涉及医疗补助和其他纳税人资助项目的欺诈计划。据与福克斯新闻数字版分享的信息显示,其医疗保健欺诈“打击小组”目前在25个联邦地区开展工作,并已对约5000人提起诉讼。

佛罗里达州高管因2.33亿美元奥巴马医改欺诈案被判入狱,该案针对无家可归者和飓风受害者

但在司法部能够追查新线索之前,可能必须梳理大量有缺陷的数据。

DOGE早期分享的信息可能不完善,因为它依赖于通过转型医疗补助统计信息系统(T-MSIS)提交的各州数据——该系统在数据质量和报告问题上存在问题,各州情况差异很大。医疗保险和医疗补助服务中心正积极致力于提高各州合规性。

关于联邦政府在发现欺诈时如何追溯“追回”各州的医疗补助资金,目前仍存在疑问。

其他人警告称,调查可能会受到新的或棘手的法律挑战的阻碍——包括隐私问题、诉讼时效问题和证据障碍。

对医疗保健欺诈的重视反映了特朗普和司法部长帕姆·邦迪(Pam Bondi)更广泛的执法优先事项。邦迪在佛罗里达州建立了打击阿片类药物、毒品走私和所谓“药房工厂”的起诉记录。

这种执法姿态为联邦检察官提供了更多资源,特别是在司法部医疗保健欺诈部门。该部门成立于2007年,近年来随着官员们应对日益复杂和大规模的欺诈计划,其工作范围和资金都有所扩大。

该部门得益于2017年成立的数据分析团队,以及去年年底新宣布的医疗保健欺诈数据“融合中心”。该中心利用司法部的刑事和欺诈部门、联邦调查局以及包括卫生与公众服务部监察长办公室在内的外部机构,利用云计算、人工智能和其他分析工具,以几年前难以想象的速度和规模更快地识别和起诉公共和私营部门的大规模医疗保健欺诈行为。

一位了解该部门运作的司法部官员告诉福克斯新闻数字版,这一举措使检察官能够更早地识别所谓的“异常”医疗服务提供者。

“这不仅是被动起诉——而是主动起诉,使用数据分析,”该人士表示。

新的数据分析工具在帮助司法部起诉广泛的医疗保健欺诈案件以及重大处方药案件中发挥了关键作用。

一位官员指出,最近一名加利福尼亚远程医疗公司创始人兼首席执行官被判20年监禁,罪名是通过虚假和欺诈性信息在网上非法开具和分发约4000万片阿片类药物Adderall(第二类受控物质)。

司法部在该案中使用的工具在迅速识别这起1亿美元的欺诈计划中发挥了关键作用。

点击此处获取福克斯新闻应用程序

2025年,司法部医疗保健欺诈部门宣布了其历史上最大规模的全国性医疗保健欺诈打击行动,追回估计150亿美元损失和没收款项,并向公众返还创纪录的5.6亿美元。

布里安娜·德皮施(Breanne Deppisch)是福克斯新闻数字版的全国政治记者,报道特朗普政府,重点关注司法部、联邦调查局和其他全国性新闻。她此前曾在《华盛顿 examiner》和《华盛顿邮报》报道全国政治,还为《Politico Magazine》、《科罗拉多公报》等媒体撰稿。你可以通过Breanne.Deppisch@fox.com向布里安娜提供线索,或在X平台上关注她@breanne_dep。

The Department of Government Efficiency’s release of years of anonymous, open-source Medicaid data was hailed by former DOGE chief Elon Musk as a transparency win that will make fraud “easy to find.” But turning internet sleuthing into prosecutions could prove far harder for the Justice Department— and legally messy.

Prosecutors and privacy experts warn the leap from anonymous tips to a courtroom case runs through three choke points: patient privacy, proof standards and the uneven quality of state-reported Medicaid data.

The DOGE data will include aggregate-level information about providers, claims, and other general information, according to the Department of Health and Human Services. Senior Trump administration officials have stressed that any information released will be done in accordance with federal privacy laws, in order to avoid identifying individuals or sharing private medical information.

The release comes as the Justice Department ramps up healthcare fraud enforcement, particularly targeting schemes involving Medicaid and other taxpayer-funded programs. Its healthcare fraud “strike force” now operates across 25 federal districts and has brought charges against roughly 5,000 individuals, according to information shared with Fox News Digital.

FLORIDA EXECS SENTENCED IN $233M OBAMACARE FRAUD THAT TARGETED HOMELESS, HURRICANE VICTIMS

But before the Justice Department can chase down new leads, it may have to sort through mountains of flawed data.

Information shared by DOGE in its early days may be imperfect due to its reliance on state data submitted through the Transformed Medicaid Statistical Information System, or T-MSIS — a system that has struggled with data quality and reporting issues that vary widely from state to state. The Centers for Medicare & Medicaid Services is actively working to improve state compliance.

There are open questions as to how the federal government might seek to retroactively “claw back” Medicaid reimbursements from states, in the event fraud is detected.

Others have cautioned that investigations could be hindered by new or thorny legal challenges — including privacy concerns, statute of limitations questions and evidentiary hurdles.

The emphasis on healthcare fraud reflects a broader enforcement priority for Trump and Attorney General Pam Bondi, who built her prosecutorial profile in Florida cracking down on opioids, drug trafficking, and so-called “pill mills.”

That enforcement posture has translated into expanded resources for federal prosecutors, particularly within the Justice Department’s Health Care Fraud Unit. Formed in 2007, the unit has grown in scope and funding in recent years as officials confront increasingly complex and large-scale fraud schemes.

The unit has benefited from the creation of its data analytics team in 2017 and the newly announced healthcare fraud data “fusion center” late last year. The center draws on DOJ’s criminal and fraud divisions, the FBI and outside agencies, including HHS-OIG, to leverage cloud computing, artificial intelligence and other analytics tools to more quickly identify and prosecute sweeping healthcare fraud in the public and private sectors, at a rate and scope that would have been unimaginable just years ago.

A Justice Department official with knowledge of the unit’s operations told Fox News Digital that the effort allows prosecutors to identify so-called “outlier” providers earlier.

“It’s an area of work that’s not only reactive prosecutions — but proactive prosecutions, using data analytics,” this person said.

The new data analytics have been crucial to helping DOJ develop and prosecute widespread instances of healthcare fraud cases, as well as major prescription drug cases.

One official pointed to the recent conviction of a California telehealth company founder and CEO who was sentenced to 20 years in prison for illegally prescribing and distributing roughly 40 million Adderall pills, a Schedule II controlled substance, over the internet using false and fraudulent information.

The tools the Justice Department used in that case were critical in quickly identifying the $100 million scheme.

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The Justice Department’s Health Care Fraud Unit announced the largest-ever national healthcare fraud takedown in its history in 2025, securing an estimated $15 billion in losses and forfeitures and returning a record $560 million to the public.

Breanne Deppisch is a national politics reporter for Fox News Digital covering the Trump administration, with a focus on the Justice Department, FBI and other national news. She previously covered national politics at the Washington Examiner and The Washington Post, with additional bylines in Politico Magazine, the Colorado Gazette and others. You can send tips to Breanne at Breanne.Deppisch@fox.com, or follow her on X at @breanne_dep.

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