In a case highlighting the ongoing scrutiny of healthcare fraud, Miguel Saravia, the CEO of Dana Group Associates and former COO of Prime Behavioral Health, has been charged with orchestrating a fraudulent billing operation that spanned from 2017 to 2023; as detailed in a Department of Justice release, Saravia, 42, will plead guilty to six counts of healthcare fraud with an unsettled plea hearing date.

Saravia's charge springs from allegations that he directed untrained individuals to misuse procedural codes for non-delivered therapy services and that he upcoded sessions to reflect more complex, costlier services than those actually provided which inflated the reimbursements from health care benefit programs, the repercussions for these actions could include up to a decade in prison, three years of supervised release, and fines possibly reaching $250,000, or double the ill-gotten gains or losses.

Health care fraud, as charged, carries significant legal ramifications, potentially leading to a maximum of 10 years in prison, supervised release post-incarceration, and hefty fines—a clear signal that federal authorities continue to tighten the reins on healthcare billing practices.

Multiple agencies collaborated in the investigation, including the U.S. Attorney's Office, HHS-OIG, FBI, Insurance Fraud Bureau, and IRS Criminal Investigations, their coordinated efforts underscore a sustained crackdown on fraudulent schemes within the health care system; the Assistant U.S. Attorneys of the Health Care Fraud Unit and the Affirmative Civil Enforcement Unit are managing the prosecution of Saravia's case.

While the charging document lays out the allegations against Saravia, it remains a legal standard that he is considered innocent until proven guilty beyond reasonable doubt—a distinction that upholds the fundamental rights within the American judicial system.