Medicare Fraud Alert: Doctors Sentenced, Seniors Exploited (January 2026)
In our last blog post, “Medicare Fraud and Scams Are on the Rise: Here’s How You Can Protect Yourself,” we shared common schemes scammers use and practical steps you can take to safeguard your Medicare benefits. Unfortunately, those scams aren’t just theoretical — they’re happening every day, and they’re causing real harm. This month’s Medicare Fraud Alert highlights recent national cases where doctors, executives, and medical providers were held accountable for exploiting Medicare and targeting seniors. These enforcement actions serve as a powerful reminder of why staying informed, vigilant, and proactive is so important.
The cases below show what happens when Medicare fraud goes unchecked—and why “Protect. Detect. Report.” is more important than ever.
Doctor Sentenced for Fraud Scheme
Dr. Timothy Sutton was sentenced to more than five years in prison for his role in a health care billing conspiracy intended to fraudulently bill Medicare for over $14.5 million. He was also ordered to pay nearly $6 million in restitution.
According to court documents, Sutton worked with two telemedicine companies that supplied him with pre-completed orders for durable medical equipment (DME), such as braces, and cancer genetic testing (CGx). Federal investigators found that Sutton digitally signed these orders without examining patients or having legitimate medical relationships with them.
Executives Convicted for Exploiting Seniors
Michael Kochen and Sandro Herek were convicted for targeting Medicare Advantage beneficiaries through deceptive telemarketing practices. Trial evidence showed that elderly individuals were pressured into accepting medical equipment they did not need—and in some cases did not want.
Physicians frequently issued standardized or boilerplate medical authorizations based only on call recordings rather than individualized medical evaluations. In many cases, doctors never spoke directly with the beneficiaries.
Doctor Charged in Botox Scheme
Dr. Violetta Mailyan, owner and operator of Healthy Way Medical Center, was charged with allegedly submitting more than $45 million in false claims to Medicare for Botox injections. She is also accused of obstructing a criminal investigation by submitting falsified medical records in response to a grand jury subpoena.
According to investigators, Mailyan billed Medicare for medically unnecessary Botox injections that were never provided—including on dates when she was traveling internationally and when the clinic was closed.
Update: Pair Sentenced for Exploiting Adult Day Care Patients
In an update to an August 24, 2022 case, Dr. Osama Nahas and Isabel Pruneda were sentenced to 10 years and more than eight years in prison, respectively. Both were also ordered to pay over $3.1 million in restitution.
Nahas, the owner and physician at Crosspoint Medical Clinic, traveled to adult day care centers to order unnecessary lab tests and prescriptions for elderly and vulnerable clients. Pruneda, a medical assistant, assisted in the scheme by forging patient signatures on consent forms and misappropriating expensive medications, including pain creams.
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Area Agency on Aging (AAA) is a private non-profit agency, designated by the state to address the needs and concerns of all older persons at the regional and local levels.
The Senior Medicare Patrol (SMP) program is dedicated to safeguarding Medicare beneficiaries, their families, and caregivers from healthcare fraud, errors, and abuse. SMP does this through outreach, education, and counseling.
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