Chiropractor accused of posing as doctor in $2 billion L.A. fraud bust; Amazon, Google and Meta push prior auth fixes; CMS can now exclude physicians on its own — Morning Medical Update Weekly Recap

Chiropractor accused of posing as doctor in $2 billion L.A. fraud bust

Prosecutors say one scheme billed private insurers more than $1.6 billion for sham addiction treatment.

The U.S. Attorney’s Office for the Central District of California announced charges Oct. 22 against 15 defendants, including six medical professionals, in schemes prosecutors say produced approximately $2 billion in fraudulent claims to government and private health care programs.

Hany Malek, 61, a Tarzana chiropractor, and Harold Tabaie, M.D., 78, an Anaheim cardiothoracic surgeon, are charged with a $135 million scheme to bill Medicare for medically unnecessary atherectomies, an invasive procedure that clears plaque from arteries.

Prosecutors allege Malek posed as a medical doctor to recommend the procedures and Tabaie performed them on patients who did not have arterial disease. FBI agents took Malek into custody in Tarzana Thursday morning.

A $1.6 billion addiction treatment case

The largest case accuses Nathan Young, 39, and David Young, 71, of billing private insurers more than $1.6 billion for sham substance abuse treatment, which the department called the largest case of its type it has prosecuted. Prosecutors allege the Youngs directed that patients who tried to leave be drugged.

Fraud actions in California and New York

Earlier in the week, the Centers for Medicare & Medicaid Services (CMS) deferred another $1.2 billion in California Medicaid payments for personal home care services. Sen. Alex Padilla (D-California) said the decision “will hurt older Californians, people with disabilities and those recovering from illness or injury.”

Federal and state agents also searched adult day care centers across New York City Oct. 20, though no charges have been announced in that probe. Charges are allegations, and defendants are presumed innocent until proven guilty.

Amazon, Google and Meta push prior authorization fixes for self-funded plans

The employers’ statement carries no deadlines, and physicians have doubted the insurer pledge it builds on.

CMS and the Department of Labor announced Oct. 21 that Amazon, Axon Enterprise, Google, Meta and Oracle signed a statement supporting electronic prior authorization for self-funded employer health plans.

Those plans, which CMS says cover more than 180 million Americans, typically rely on third-party administrators for prior authorization and weren’t directly covered by the 2025 insurer pledge.

The statement asks pledge participants to make electronic prior authorization tools immediately available to self-insured plan sponsors and to offer other reforms, such as fewer services requiring approval, for each plan to consider.

CMS Administrator Mehmet Oz, M.D., said patients and doctors shouldn’t have to “fall back on faxes and paperwork simply because of how a patient’s health plan is funded.”

No targets or deadlines

The statement includes no numeric targets or deadlines. Insurers reported in April that they had cut prior authorizations by 11% under the pledge, but in an American Medical Association survey of 1,000 physicians released in May, only 33% said the pledge would make a meaningful difference. Physicians in the survey reported completing an average of 40 prior authorizations a week.

CMS can now exclude physicians from federal health programs on its own

Attorneys say the agency hasn’t spelled out what conduct would trigger exclusion or how physicians would appeal.

Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. delegated permissive exclusion authority under Section 1128(b) of the Social Security Act to the CMS administrator in a Federal Register notice published Oct. 14 and effective immediately.

Until then, the HHS Office of Inspector General (OIG) was the only federal body that could exclude individuals and entities from all federal health programs. OIG keeps that authority, and the delegation doesn’t let CMS hold hearings or issue regulations.

What can get a physician excluded

Grounds for permissive exclusion include:

• Kickbacks and other prohibited activities.
• License revocations or suspensions.
• Excessive charges or unnecessary services.
• Certain fraud-related misdemeanor convictions.

What attorneys are saying

An excluded individual “really can’t have a job at any kind of organization that bills federal healthcare programs,” Tony Maida, a partner at McDermott Will & Schulte, told Healthcare Brew. The outlet reported that CMS revoked billing privileges for 5,586 providers and suppliers in 2025.

“It really can be a death penalty for a provider.” — Jeff Wurzburg, partner, Norton Rose Fulbright

Wurzburg told HFMA that without knowing when CMS would use the authority, “it could have a real chilling effect on providers [in disputing audits].”