What are the latest government estimates of annual healthcare fraud losses in the US (2023-2025)?
Executive summary
Government figures and law‑enforcement tallies offer different slices of the problem: official recoveries and takedown “intended losses” ran from about $1.8–$3.4 billion in FY2023 reporting to multi‑billion enforcement actions in 2024–2025 (e.g., DOJ/HHS joint recoveries and takedown figures of $2.7B in 2024 and intended losses of $14.6B in the 2025 takedown) [1] [2] [3]. Independent estimates and watchdog work place annual improper payments and marketplace fraud far higher — GAO and others flag over $100 billion in Medicare/Medicaid improper payments in 2023 and marketplace improper payments as high as $27 billion annually — while industry groups give broad ranges (tens of billions up to 3–10% of total spending) [4] [5] [6].
1. What the federal enforcement numbers actually measure — recoveries, charges and “intended losses”
Federal reports usually report three different metrics: recoveries/settlements won by the government, criminal charges with alleged loss amounts, and programmatic estimates of improper payments. The HHS‑OIG’s HCFAC report cites civil settlements and judgments exceeding $1.8 billion for FY2023 [1]. DOJ and HHS press releases describe enforcement actions that cite “intended” or “alleged” losses far larger — for example DOJ described $2.7 billion in alleged healthcare fraud in a 2024 national enforcement action [2], and the 2025 national takedown cited intended losses exceeding $14.6 billion [3]. Those larger takedown figures report what defendants are accused of, not net losses finally returned to taxpayers [2] [3].
2. Improper payments and program error: GAO’s much larger totals
Separate from fraud prosecutions, GAO and program integrity reviews quantify improper payments and payment errors that include fraud, waste and administrative mistakes. GAO reported “over $100 billion worth” of improper payments in Medicare and Medicaid in 2023 — a programmatic accounting of suspect outlays that is not the same as criminal fraud totals [4]. Watchdogs and some congressional analyses treat parts of those improper payments as fraud‑exposed, which raises headline dollar figures well above enforcement recovery numbers [4] [5].
3. Industry and watchdog estimates give wide ranges — tens of billions to percentages of spending
The National Health Care Anti‑Fraud Association and others commonly cite that tens of billions are lost annually to health‑care fraud; some conservative rules‑of‑thumb put fraud at ~3% of health spending and some law‑enforcement estimates go as high as 10%, which, given U.S. health spending, translates into scores or hundreds of billions [6] [7] [8]. Those percentages are high‑level estimates that mix fraud, waste and abuse and are not reconciled to DOJ or HHS recoveries [6] [7].
4. Recent trends (2023–2025): enforcement is up, but so are alleged losses
Enforcement reporting shows a return to vigorous activity after pandemic slowdowns. HCFAC and DOJ data show large recoveries and many high‑value settlements in FY2023 (HCFAC civil settlements >$1.8B) and continuing large enforcement actions in 2024–2025 — DOJ cited $2.7B in alleged fraud linked to recent actions [1] [2]. The 2025 national takedown was the largest on record in DOJ/HHS public statements, alleging $14.6B in intended losses among hundreds of defendants [3].
5. Where the big gaps and disagreements lie
Key disagreements stem from definitions and scope. “Improper payments” (GAO’s $100B+ figure) include errors and programmatic issues beyond criminal fraud [4]. Enforcement “intended losses” reflect prosecutor allegations, not adjudicated recoveries [2] [3]. Industry associations and anti‑fraud groups often combine private insurer losses and public program fraud when citing “tens of billions” or percentage estimates; those figures are not directly comparable to DOJ/HHS settlement totals [7] [6].
6. What readers should take away
Available sources show federal recoveries and judgments in the low billions for FY2023 (e.g., $1.8B civil settlements reported for FY2023) while enforcement actions in 2024–2025 cite much larger alleged or intended loss figures (e.g., $2.7B announced in 2024 actions and $14.6B alleged in the 2025 takedown) [1] [2] [3]. Program integrity audits and GAO flag over $100B in improper Medicare/Medicaid payments for 2023 and marketplace analyses estimate up to $27B in ACA subsidy improper payments — figures that expand the policy debate but are not synonymous with confirmed criminal fraud [4] [5].
Limitations and sources: This analysis relies on HHS‑OIG, DOJ, GAO and industry/watchdog reporting in the provided documents; those sources use different definitions (recoveries vs. alleged losses vs. improper payments), which explains the divergent headline numbers [1] [2] [4] [6]. Available sources do not mention a single, consolidated government estimate that states an agreed U.S. annual healthcare fraud loss figure covering 2023–2025.