Defrauding Medicare or Medicaid Could Put Citizenship at Risk, DOJ Says

 Doctors and other naturalized citizens who commit Medicare or Medicaid fraud could be stripped of their citizenship, according to a new memo

opens in a new tab or window from the Department of Justice (DOJ).

"The Department of Justice may institute civil proceedings to revoke a person's United States citizenship if an individual either 'illegally procured' naturalization or procured naturalization by 'concealment of a material fact or by willful misrepresentation,'" the memo reads. In concert with that declaration, "The Civil Division shall prioritize and maximally pursue denaturalization proceedings in all cases permitted by law and supported by the evidence."

In particular, among the types of denaturalization cases the Civil Division will prioritize are "cases against individuals who engaged in various forms of financial fraud against the United States (including Paycheck Protection Program [PPP] loan fraud and Medicaid/Medicare fraud)," the memo says. The Justice Department did not respond by press time to a question about whether the stripping of citizenship might ever apply to U.S.-born citizens who committed fraud.

The push for denaturalization "is an audacious and dangerous move by the Trump administration to take away citizenship from individuals," Lawrence Gostin, JD, director of the O'Neill Institute at Georgetown University in Washington, said in an email. "It is likely to be used in a discriminatory way."

"Medicaid/Medicare fraud can certainly be part of a large criminal enterprise," he continued. "But this tends to be mass frauds by physician offices or networks of bad actors -- these are usually native-born U.S. citizens. Instead, this [policy] is likely to target poor people who may have asked for benefits not even knowing it was fraudulent. This policy conflates immigration policy with healthcare in the U.S. It is likely to be dangerous, discriminatory, and invidious."

Sean O'Connell, JD, a shareholder at the Baker Donelson law firm in Washington, agreed. "This policy is deeply problematic and raises serious concerns about proportionality and intent," he said in an email. "While the legal basis for denaturalization exists under [federal law], its use has historically been rare and reserved for extreme cases -- such as war crimes or national security threats. Extending it to financial fraud cases, including PPP or Medicare fraud, risks reviving the discredited tactics of the McCarthy era, when denaturalization was used to strip citizenship from suspected communists. The message this sends -- that one's citizenship is conditional and revocable -- is dangerous, especially when applied to conduct that is already prosecuted through civil and criminal channels."

The policy is "highly unlikely" to deter Medicare or Medicaid fraud, he added. "For one, the memo itself makes clear that denaturalization applies only where citizenship was obtained by fraud or concealment -- meaning its use is limited to cases where the individual both committed financial fraud and then lied about it in their naturalization application. That's an extremely narrow subset of cases. There's no empirical evidence that targeting citizenship status deters complex healthcare fraud, which usually stems from systemic failures, not immigration fraud."

It could also have unintended consequences, O'Connell said. "While the memo includes national security and human rights categories, its inclusion of healthcare fraud and PPP loan fraud risks conflating garden-variety fraud with existential threats to national safety. That's a troubling slope. Even if used narrowly, the mere existence of this policy could chill immigration and discourage highly skilled professionals -- especially in medicine and biotech -- from making the U.S. their home."

The administration's current efforts at cracking down on healthcare fraud contrast with actions taken by Trump during his first term, according to a KFF Health News storyopens in a new tab or window. In his first and second terms, Trump has granted pardons or commutations to at least 68 people convicted of fraud crimes or of interfering with fraud investigations, as found in a KFF Health News review of court and clemency recordsopens in a new tab or window, DOJ press releases, and news reports. At least 13 of those fraudsters were convicted in cases involving more than $1.6 billion of fraudulent claims filed with Medicare and Medicaid, according to the DOJ.

The office of the U.S. District Attorney in Northern Ohio recently announced an indictment in a naturalization fraud case involving a doctor, although it didn't specifically deal with Medicare or Medicaid. In that instance, Yousif Abdulraouf Alhallaq, MD, 46, of Canton, Ohio, was a Jordanian citizen who entered the U.S. in 2006 on an H1B visa and worked as a physician starting in 2012. In 2014, according to a DOJ releaseopens in a new tab or window from last week, Alhallaq poisoned a victim who was pregnant with his child in an attempt to terminate the pregnancy without her knowledge. However, in a 2017 naturalization application, he answered "No" to questions about whether he had ever tried to kill someone or tried to hurt a person on purpose. He became a naturalized U.S. citizen in 2018.

In 2021, Alhallaq was indicted and charged with one count of attempted murder and two counts of felonious assault for trying to purposely cause the termination of the victim's pregnancy and knowingly causing serious physical harm to the victim and her unborn child. In September of that year, Alhallaq pleaded guilty to the charges and was sentenced to 4 years in prison. Last month, a grand jury indicted Alhallaq for naturalization fraud because he lied on his 2017 naturalization application and also lied in 2018 when he gave the same answers to an immigration official during a verbal interview. He now faces a maximum of up to 10 years in prison for naturalization fraud.

https://www.medpagetoday.com/publichealthpolicy/medicare/116380