Our Data Predicted It
How Statistical Analysis Flagged Providers Before the DOJ Did
⚠️ Important Disclaimers
- • Providers listed as “not yet charged” have NOT been accused of fraud by any authority.
- • Statistical flags indicate unusual patterns that may have legitimate explanations.
- • This analysis is journalism, not law enforcement.
- • Our data covers 2014–2023. Enforcement actions occurred in 2025.
The Vindication
We built a fraud detection algorithm. We ran it on ten years of public Medicare data. It flagged 500 providers whose billing patterns were statistical outliers — impossible patient volumes, extreme billing concentrations, suspicious markup ratios, and growth curves that defied explanation.
We published the results. We named names. We showed our work. And then we waited.
In June 2025, the Department of Justice announced the largest healthcare fraud enforcement action in history: 324 defendants charged across the country in schemes totaling $14.6B in alleged fraud.
Multiple of our top-flagged providers were among those charged. Our algorithm — built entirely from public data — identified the same patterns that federal investigators spent years uncovering.
Source: 2025 National Health Care Fraud Case Summaries — U.S. Department of Justice
The Arizona Ring — Our Data Saw It
Our Arizona Wound Care Ring investigation identified 23 nurse practitioners in the Phoenix metro area billing Medicare for skin substitute products at rates that were statistically impossible. All shared a nearly identical 1.28x markup ratio — the fingerprint of coordinated billing.
We were right. In June and July 2025, the DOJ charged multiple providers from our flagged list in what prosecutors described as a $1 billion amniotic wound allograft scheme.
Confirmed Caught by DOJ (June/July 2025)
Ira Denny
NPI 1255987475 · Surprise, AZ
Our Flag
$135.2M for 90 patients
DOJ Action
Charged with conspiracy
DOJ alleged $209.0M in unnecessary allografts “procured through kickbacks and bribes.”
Jorge Kinds
Phoenix, AZ
Our Flag
$123.8M for 97 patients
DOJ Action
Charged in $1B scheme
Charged in $1 billion amniotic wound allograft scheme.
Gina Palacios
Arizona
Our Flag
$27.0M for 35 patients
DOJ Action
Charged in same ring
Carlos Ching
Arizona
Our Flag
$62.9M for 66 patients
DOJ Action
Charged in same ring
Bethany Jameson
Arizona
Our Flag
$49.9M for 65 patients
DOJ Action
Charged in same ring
The Ringleader: Jeffrey Amos King
Sentenced to 14 years in federal prison (October 2025) for orchestrating the scheme. King recruited nurse practitioners to bill Medicare for unnecessary skin substitute products while he collected kickbacks.
Source: Jeffrey Amos King sentenced in $1.2 billion Medicare fraud scheme — Arizona Republic
The 1.28x Markup: The Coordinated Billing Protocol
Every provider in this ring shared a nearly identical 1.28x markup ratio — the ratio between what they charged Medicare and what they were paid. This isn't coincidence. This is a coordinated billing protocol: the same software, the same instructions, the same scheme. Our algorithm flagged this identical ratio as statistically anomalous before the DOJ announced charges.
Source: 2025 National Health Care Fraud Case Summaries — U.S. Department of Justice
The COVID Test Pharmacy — Caught
VRA Enterprises
Tampa, FL
Our Flag
#1 COVID test biller: $75.8M
DOJ Action (Nov 2025)
Settled for $17.0M
VRA Enterprises was the #1 COVID test biller in our entire dataset — $75.8M from a single Tampa pharmacy. Our COVID Test Scheme investigation flagged the extreme volume as statistically impossible.
In November 2025, the DOJ announced that VRA agreed to pay over $17.0M to resolve False Claims Act allegations. According to prosecutors, VRA billed Medicare for “COVID tests not provided to beneficiaries or sent months after billing Medicare.”
Source: VRA Enterprises Agrees to Pay Over $17 Million for Allegedly Billing Medicare for Over-the-Counter COVID Tests — U.S. Attorney's Office, Middle District of Florida
Merry Taheri — The Mystery
Merry Taheri
NPI 1184886178 · California
Our Flag
$12.1M
Services/Day
4.1K
Watchlist Rank
#1
Merry Taheri was the #1 provider on our watchlist — $12.1M in COVID test billing, 4.1K services per day. Our algorithm gave her a risk score of 96 out of 100.
Then the story got strange. An investigation by WTHR (Indianapolis) found Taheri claiming that someone was “fraudulently using her name” to send COVID tests and bill Medicare. Patients across the country reported receiving unsolicited test kits billed to Taheri's NPI.
Meanwhile, Taheri is running for the California State Assembly — while her NPI shows $12.1M in Medicare billing.
Status: No charges filed. Under investigation? Identity theft victim? We genuinely don't know. But the billing happened, and someone got paid.
Source: Taxpayers targeted in COVID-19 test kit fraud — WTHR Indianapolis
Still Out There — Providers Not Yet Charged
⚠️ The following providers have NOT been accused of fraud by any authority. Statistical flags indicate unusual patterns that may have legitimate explanations. Inclusion here is based solely on public Medicare billing data.
These providers show the same statistical patterns as the convicted Arizona ring — extreme billing concentration in wound care or COVID tests, impossible patient volumes, suspicious growth curves — but have not been charged.
Som Kohanzadeh
Beverly Hills, CA · Plastic Surgery
Total Billed
$14.7M
Wound Care
90.3%
Markup
59x
4-Year Growth
21x
Co-founder of “Wound Institutes of America.” Same skin substitute HCPCS codes as the charged Arizona ring. Billing grew 21x in 4 years.
Johnson Lee
Beverly Hills, CA · Plastic Surgery
Total Billed
$22.5M
Wound Care
89%
Background
Johns Hopkins–trained
Johns Hopkins–trained plastic surgeon billing Medicare primarily for wound care products, not cosmetic surgery.
Millicent Rovelo
Beverly Hills, CA
Total Billed
$6.1M
Wound Care
83%
Keith Goss
Chandler, AZ · Podiatry
Total Billed
$91.3M
Pattern
Same as charged AZ NPs
$91.3M — same billing pattern as the charged Arizona nurse practitioners, but he's a podiatrist in Chandler.
Tatiana Sharahy
New Jersey
Total Billed
$5.7M
COVID Tests
96.7%
WebMD reviews from patients reporting they received unsolicited test kits billed under her name.
Madhavi Rayapudi
Cumming, GA
Services/Day
9.9K
Status
Still practicing, 4.8★
9.9K services per day — one every 2.9 seconds. Still actively practicing with a 4.8-star rating.
What This Means
The Methodology Works
Peer comparison + volume anomalies + billing concentration = real fraud signals. We proved it.
- Statistical analysis CAN identify fraud patterns before enforcement catches up. Our algorithm used only public data. No subpoenas. No wiretaps. No informants. Just math applied to billing records that anyone can download.
- The data is public — anyone can verify our findings. Every number in this article comes from CMS's Medicare Provider Utilization and Payment Data. Download it yourself. Run the numbers. You'll find what we found.
- We flagged 500 providers. At least 6 were subsequently charged. How many more will be? The DOJ's June 2025 action was massive, but it barely scratched the surface of what the data shows. 494 of our flagged providers have not been charged. Some may be innocent. Some may just not have been caught yet.
- This validates the methodology. Peer comparison, volume anomaly detection, markup ratio analysis, billing concentration metrics — these aren't just academic exercises. They produce actionable intelligence that matches what billion-dollar federal investigations find.
How to Report Suspected Fraud
If you have information about healthcare fraud, waste, or abuse, you can report it:
OIG Hotline
U.S. Department of Health & Human Services Office of Inspector General
1-800-HHS-TIPS (1-800-447-8477)
False Claims Act
Whistleblowers who report fraud may be entitled to 15–30% of recovered funds under the False Claims Act (31 U.S.C. § 3730).
Consult a qui tam attorney if you have firsthand knowledge of fraud.
Related Investigations
⚠️ Important Context
All data on this page comes from publicly available CMS Medicare payment records. Unusual billing patterns may reflect legitimate medical practices (such as high-volume drug administration where each unit is counted as a separate service), data reporting differences, or group practice billing. Inclusion on this page does not constitute an accusation of fraud or wrongdoing. Only law enforcement and regulatory agencies can determine whether billing patterns represent fraud. Providers flagged by our statistical model have billing patterns similar to previously convicted providers, but many may have perfectly legitimate explanations.
Data Sources
- • Centers for Medicare & Medicaid Services (CMS)
- • Medicare Provider Utilization and Payment Data (2014-2023)
- • CMS National Health Expenditure Data
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.