Business plans have been explicitly in scope
This isn’t a Medicare-only drawback. The Apex Medical case – during which Alexandra Gehrke was sentenced to fifteen.5 years in jail on October 7, 2025, and Jeffrey King to 14 years on October 10, 2025, with a $309 million civil settlement introduced in December – generated greater than $1.2 billion in false claims over 18 months, of which over $960 million was billed to federal applications together with Medicare, TRICARE and CHAMPVA, with the rest billed to different medical insurance applications, in line with DOJ information. A associated 2025 case involving co-defendants Kontos, Kupetz and Sorts made the business payer publicity specific: the DOJ’s personal case abstract states their scheme submitted false claims to “Medicare, CHAMPVA, TRICARE, and business insurers.” Business insurers have been immediately in scope. The quantities paid by personal plans haven’t been individually disclosed.
