BREAKING NEWS: FinCEN Targets Healthcare Fraud, Pitches Whistleblower Rule

U.S. officials warned financial services companies in an 18-page advisory Monday to optimize their efforts to detect and flag transactions potentially related to fraud schemes targeting Medicare, Medicaid, and other healthcare programs "in Minnesota and across the country."

Suspicious activity reports filed on potential instances of healthcare fraud in the U.S. rose more than 330 percent from 2020 to more than 3,800 submissions in 2025, a total that, according to the bureau that issued the advisory, the Financial Crimes Enforcement Network, probably does not reflect the true volume of the crime.

Perpetrators often use non-resident aliens, the stolen identities of retired physicians and other individuals as strawmen to open shell companies, then register those entities as healthcare providers or suppliers, open bank accounts for them and submit fraudulent claims for reimbursement, FinCEN advised.

"This is often facilitated by paying kickbacks and bribes through recruiters and marketers to complicit doctors, nurses, pharmacists, and other medical professionals for fraudulent, nonexistent, exploitative, or unnecessary medical care," the bureau warned. "This practice can include kickbacks and bribes for patient referrals, prescriptions and doctors' orders."

The advisory includes a list of 21 potential indicators of healthcare fraud against which banks and other financial services companies should screen customers and their transactions.

Customers who have nominal and beneficial owners associated with their accounts who also have access to accounts for other "separate and distinct" health care providers or suppliers warrant scrutiny, as do customers logging in from IP addresses linked to other accounts at the same institution, other institutions or other jurisdictions, FinCEN noted.

FinCEN separately issued a notice of proposed rulemaking, or NPRM, on Monday that would formally establish a program to incentivize and encourage individuals to share potential leads on fraud-related violations of the Bank Secrecy Act, breaches of U.S. sanctions and other laws.

The NPRM would fully implement the Anti-Money Laundering Act of 2020 and AML Whistleblower Improvement Act of 2022, pursuant to which the bureau is already accepting such tips from whistleblowers, by codifying protections for them and establishing monetary awards equal to 10 to 30 percent of any penalties collected as a result of their assistance.

Moneylaundering.com may update this coverage as more information becomes available. 

• Topics: Anti-Money Laundering and Countering the Finance of Terrorism, Fraud
• Source: U.S.: FinCEN