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Silent Fraud

Healthcare-7
Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

“Silent but not silenced.” A phrase that distinguishes the difference between choosing to be quiet and being prevented from speaking. The difference between voluntary silence and imposed silence. One might choose to be silent for various reasons, like taking a break from a conversation or not wanting to engage at all. Or even committing fraud! Or maybe like Peter Roussonicolos, owner of five Durable Medical Equipment (DME) suppliers, who was supposed to be a silent partner. However, he was far from quiet, when it came to stealing thousands of millions of dollars from the U.S. taxpayer in a Medicare scheme.

Roussonicolos had to hide his involvement in the companies from Medicare because he had one or more felony convictions, making him ineligible to enroll with the government Medicare program. So Roussonicolos recruited and paid co-conspirators to serve as nominee owners of the DME suppliers, falsifying the Medicare enrollment forms, bank records, and other documents to conceal the true ownership and control of the DME suppliers. Fake owners who paid kickbacks and bribes to patient recruiters in exchange for beneficiary referrals. 

With those referrals, Roussonicolos submitted approximately $61.5 million in false and fraudulent claims from his DME suppliers to Medicare for medically unnecessary DME that was ineligible for reimbursement. Medicare paid approximately $26.7 million of these claims.

On July 7, 2025, Peter Roussonicolos was sentenced to 12 years in prison for Medicare fraud. He was ordered to pay $21 million in restitution.

Shout out to the Department of Justice. This case was part of the DOJ’s Health Care Fraud Strike Force effort. On June 30, the DOJ charged 324 individuals in a $14.6 billion healthcare fraud crackdown, marking the largest coordinated enforcement action in its history. Roussonicolos is just the first of many fraudsters.

Today’s Fraud of The Day is based on article “DME owner sentenced to 12 years for $61M Medicare fraud” published by Medical Update on July 7, 2025.

A Florida man has been sentenced to 12 years in prison for masterminding a $61.5 million Medicare fraud scheme involving false claims for durable medical equipment (DME). Prosecutors say Peter Roussonicolos, 64, secretly owned five DME companies despite prior felony convictions, using straw owners and falsified documents to hide his involvement.

The companies paid kickbacks for patient referrals and billed Medicare for medically unnecessary equipment, receiving $26.7 million in payments. Roussonicolos must also pay over $21 million in restitution and forfeiture. The case was part of the Department of Justice’s.

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