Commercial plans were clearly in scope
This isn’t just a Medicare problem. The Apex Medical case – in which Alexandra Gehrke was sentenced to 15.5 years in prison on October 7, 2025, and Jeffrey King was sentenced to 14 years to life on October 10, 2025, with a $309 million civil settlement announced in December – generated more than $1.2 billion in false claims in 18 months, of which $960 million More were billed to federal programs including Medicare, TRICARE, and Champaign. The remainder were billed to other health insurance programs, according to DOJ records. A 2025 case involving co-defendants Kontos, Kupetz, and Kinds made the commercial payer’s risk clear: the DOJ’s own summary of the case said their scheme submitted false claims to “Medicare, Champaign, Tricare, and commercial insurers.” Commercial insurers were directly in scope. The amount paid by private schemes has not been disclosed separately.
