John C. Rezk, Medicare Billing Fraud, Pennsylvania 2024

John C. Rezk, owner and CEO of Horizons Hospice, LLC, has agreed to pay $1,240,000 to settle two whistleblower lawsuits accusing his company of systematic Medicare and Medicaid fraud. Federal prosecutors in Pittsburgh announced the resolution today, alleging Rezk and his company billed federal health programs for hospice services given to patients who were not terminally ill—many of whom had life expectancies far exceeding the required six-month threshold.

The fraud spanned from June 27, 2007, to August 1, 2012, during which time Horizons Hospice, later renamed 365 Hospice, LLC, knowingly submitted false claims for reimbursement. Federal health care programs only cover hospice care for patients with a prognosis of six months or less to live. Investigators allege Rezk and his company not only admitted ineligible patients but falsified medical records to fabricate terminal diagnoses and justify billing.

The settlement resolves two False Claims Act lawsuits filed under seal in the U.S. District Court for the Western District of Pennsylvania: United States ex rel. Thomas v. Horizons Hospice LLC (No. 12-cv-315) and United States ex rel. Mizak, et al. v. Horizons Hospice LLC, et al. (No. 13-cv-1688). Whistleblowers, often former insiders, stand to receive a portion of the recovery for exposing the fraud.

“Medicaid and Medicare are programs intended to provide care and assistance to the most vulnerable members of our communities, including seniors,” said U.S. Attorney Scott W. Brady. “Those who seek to defraud these programs will be vigorously pursued by my office. This settlement is another step forward in that fight.”

The investigation was led by the Office of Inspector General of the U.S. Department of Health and Human Services, with support from the Federal Bureau of Investigation. Assistant U.S. Attorneys Paul E. Skirtich and Rachael L. Mamula handled the case for the government, peeling back layers of falsified documentation and billing records to expose the scheme.

The claims settled are allegations only, and there has been no determination of liability. Still, the $1.24 million payout sends a clear message: profiting off the dying by gaming the system will trigger federal scrutiny and steep consequences.