Commercial plans were explicitly in scope
This is not a Medicare-only problem. The Apex Medical case – in which Alexandra Gehrke was sentenced to 15.5 years in prison on October 7, 2025, and Jeffrey King to 14 years on October 10, 2025, with a $309 million civil settlement announced in December – generated more than $1.2 billion in false claims over 18 months, of which over $960 million was billed to federal programs including Medicare, TRICARE and CHAMPVA, with the remainder billed to other health insurance programs, according to DOJ records. A related 2025 case involving co-defendants Kontos, Kupetz and Kinds made the commercial payer exposure explicit: the DOJ’s own case summary states their scheme submitted false claims to “Medicare, CHAMPVA, TRICARE, and commercial insurers.” Commercial insurers were directly in scope. The amounts paid by private plans have not been separately disclosed.
