Recent judicial and law enforcement actions in the United States and India have identified systemic fraudulent activities targeting government-funded healthcare programs.

美國與印度近期採取之司法與執法行動，發現了針對政府資助醫療計畫的系統性詐騙活動。

In the United States, the Department of Justice has secured convictions against Reyad Salahaldeen and Mohamad Mustafa for their roles in a genetic testing fraud operation. Between 2018 and 2020, the defendants utilized a network of marketers to procure DNA samples under the premise of medically necessary screenings. This infrastructure facilitated the submission of approximately $522 million in fraudulent claims to Medicare, Medicaid, and private insurers, resulting in actual payouts of $84 million. The operational methodology involved the fabrication of medical necessity documentation and the disbursement of illegal kickbacks to providers who had no prior clinical relationship with the patients. Salahaldeen, a Palestinian national and permanent resident, received a sentence of 12 years and 7 months, while Mustafa received three years. Both were ordered to pay substantial restitution, totaling over $148 million collectively.

在美國，司法部已對 Reyad Salahaldeen 與 Mohamad Mustafa 定罪，因其參與了一項基因檢測詐騙行動。在 2018 年至 2020 年間，被告利用行銷網絡，以醫療必需篩檢為前提獲取 DNA 樣本。此架構促成了向 Medicare、Medicaid 及私人保險公司提交約 5.22 億美元的虛假索賠，導致實際賠付金額達 8,400 萬美元。其運作手法包括偽造醫療必需證明文件，以及向與患者先前無臨床關係的醫療提供者支付非法回扣。Salahaldeen 為巴勒斯坦公民及永久居民，被判處 12 年 7 個月監禁，而 Mustafa 則被判處 3 年。兩人均被命令支付巨額賠償，總計超過 1.48 億美元。

Parallelly, the Special Operations Group in Rajasthan, India, has disrupted a fraudulent nexus within the Rajasthan Government Health Scheme (RGHS). Investigations led by Additional Director General of Police Vishal Bansal revealed that Dr. Kamal Kumar Agrawal and laboratory operator Dr. Banwari Lal engaged in the generation of fictitious prescriptions and diagnostic reports. The scheme involved the billing of unnecessary MRI scans and the inflation of costs by misrepresenting standard procedures as 'contrast MRIs.' Evidence indicates that reports were fabricated for patients who were absent or admitted to disparate facilities, and referral documents were altered to ensure eligibility for state reimbursement. These actions have resulted in significant fiscal losses to the state exchequer and a degradation of the scheme's institutional credibility.

與此同時，印度拉賈斯坦邦 (Rajasthan) 的特別行動小組破獲了一個在拉賈斯坦邦政府醫療計劃 (RGHS) 內部的詐騙網絡。由警察副總監 Vishal Bansal 領導的調查顯示，Kamal Kumar Agrawal 醫生與實驗室經營者 Banwari Lal 醫生參與製造虛假的處方與診斷報告。該計劃涉及對不必要的 MRI 掃描進行計費，並將標準程序偽稱為「對比增強 MRI」以抬高成本。證據顯示，部分報告是為不在場或就診於其他機構的患者偽造的，且轉診文件被篡改以確保符合州政府報銷資格。這些行為導致州政府財政損失嚴重，並損害了該計劃的制度信譽。

Both jurisdictions are currently pursuing further investigations to identify additional co-conspirators and recover misappropriated public funds.

兩個司法管轄區目前均在進行進一步調查，以識別其他共謀者並追回被挪用的公共資金。