The latest charges, investigations, settlements, and sentencing related to health care fraud.
Nursing home companies to pay $15M in restitution for fraud
Companies that operate two Pittsburgh-area nursing homes were sentenced in federal court to pay more than $15 million in restitution for making false statements in connection with the payment of health care benefits and for obstructing and impeding the investigation and proper administration of a matter within the jurisdiction of the Centers for Medicare & Medicaid Services (CMS).
Comprehensive Healthcare Management Services, LLC, which operated Brighton Rehabilitation and Wellness Center, and Mt. Lebanon Operations, LLC, which ran Mount Lebanon Rehabilitation and Wellness Center, were found guilty on six and four counts, respectively, by a federal jury in December 2023.
United States District Judge Robert J. Colville ordered Brighton to pay $12.6 million in restitution to the U.S. Department of Health & Human Services in addition to serving five years of probation and Mt. Lebanon to pay $2.7 million in restitution and to serve one year of probation.
“Protecting the health, safety, and dignity of the residents of these nursing facilities and ensuring adequate staff to care for these vulnerable resident populations has been our office’s primary focus and objective throughout this prosecution,” said Acting U.S. Attorney Troy Rivetti in the announcement. “Choosing to prioritize profits over patient care, these facilities lied and falsified records regarding meeting minimum requisite staffing levels to avoid sanctions and to continue to receive federal funding, all the while failing to provide residents with the level and quality of care they deserved.”
Evidence presented at the December 2023 trial established that, acting through high-level personnel and other employees, Brighton and Mt. Lebanon falsified staffing information provided to the Pennsylvania Department of Health and CMS to show that the facilities complied with the conditions of participation in Medicare and Medicaid. The false certifications—which included, for example, various employees adding the names of individuals who were not actually working, not providing direct patient care, and, in some cases, not even in the building, to staffing sheets to make it appear that the requisite minimum staffing ratio was being met—enabled the corporations to evade penalties for failing to provide sufficient staffing to meet the needs of the residents.
In addition, testimony established that the facilities continued to push for new patient admissions despite low staffing levels and nurses at the facilities advising that they could not adequately care for additional residents.
Prior to imposing sentence, Colville heard testimony and received impact statements from family members of several former residents of the facilities, including a female resident who was seriously injured from a violent physical assault by a male resident when no nursing home staff were present to prevent the abuse or come to the victim’s aid. These family members described a significant decline in staffing following the acquisition of the nursing homes by Comprehensive Healthcare Management Services, LLC, and Mt. Lebanon Operations, LLC, and detailed how decreased staffing levels negatively impacted their relatives’ care, treatment, health, well-being, and hygiene.
In imposing sentence, Colville described the defendants’ actions as “a tragic set of events” that not only increased the risk of inadequate care for the facilities’ patients but also impacted the lives of the facilities’ employees and the general public, who expect that health care facilities will operate lawfully. He noted that the nursing facilities’ actions resulted in the government and taxpayers being defrauded and the loss of care to patients.
Foreign national sentenced for $3.2M Medicare fraud scheme
A foreign national, who pleaded guilty to two counts of health care fraud in February, was sentenced last week to 30 months in prison for his role in defrauding Medicare of more than $3.2 million through a sham durable medical equipment (DME) company. He was also ordered to pay $1.5 million in restitution.
Julian Lopez, 55, a citizen of Cuba who resides in Miami-Dade County, Fla., obtained Medicare beneficiary identification cards and sold beneficiaries’ personal information to a DME company, One Medical Services. Lopez knew the Medicare identification cards he obtained would be used to submit fraudulent claims to Medicare. One Medical Services used the information from Lopez to bill Medicare for orthotic braces that were never provided to the Medicare beneficiaries. In connection with the scheme, One Medical Services submitted over $3.2 million in false and fraudulent claims to Medicare for medically unnecessary DME.
DME owner to plead guilty in $30M fraud scheme
The owner of Pharmagears, LLC (Pharmagears) and RR Medco, LLC (RR Medco) has agreed to plead guilty to a $30 million health care fraud conspiracy involving medically unnecessary DME, including orthotics such as back and knee braces.
Raju Sharma, 61, of Sharon, Mass., last week agreed to plead guilty to one count of conspiracy to commit health care fraud. Per the plea agreement, the government will recommend a sentence of 10 years in prison and more than $15.8 million in restitution.
Sharma was arrested and charged by criminal complaint in February 2025 and subsequently released on conditions pending trial. He was later ordered detained in April 2025 after the court found that he violated the conditions of his release by contacting a potential witness.
Between February 2021 and February 2025, Sharma, on behalf of Pharmagears and RR Medco, contracted with telemarketing companies that generated DME orders by targeting Medicare beneficiaries. Sharma allegedly billed Medicare for this medically unnecessary DME, which the Medicare beneficiaries often did not want or could not use, and/or a medical practitioner ordered it without having met or examined the beneficiary, or it was ordered by the fraudulent use of practitioners’ national provider identifiers without their knowledge or assent.
The charging documents allege that Sharma worked with multiple other co-conspirators, including family and acquaintances, to open and operate additional DME companies in the same fraudulent manner. In total, the companies owned, operated, or connected with Sharma billed Medicare approximately $29.6 million for these fraudulent DME orders and were paid approximately $15.8 million.
Sharma used the profits to purchase luxury goods, including two Ferraris, a Mercedes-Benz Model S, and at least three Rolex watches. As part of the plea agreement, he has agreed to forfeit these luxury goods, as well as over $250,000 in cash investigators seized from his bank accounts.
The charge of conspiracy to commit health care fraud provides for a sentence of up to 10 years in prison, supervised release for up to three years, and a fine of up to $250,000 or twice the gross gain or loss, whichever is greater.