$90 Million Medicare Fraud Indictment: What Happens Next and Why Your Defense Starts Now

A federal grand jury in the Northern District of California just indicted Anar Rustamov on healthcare fraud charges tied to an alleged $90 million Medicare Advantage scheme. According to the DOJ, he used a shell company to submit thousands of fraudulent claims for medical equipment that was never delivered, never authorized by a provider, and in many cases never needed by the patients whose information was used.

He remains at large. But if you are reading this because you are not, the question is no longer how the indictment happened. It is what you do now.

A person in a dark suit sitting alone at a desk in a dimly lit office, reviewing federal indictment paperwork, representing the moment after a federal healthcare fraud indictment lands

A federal indictment is the beginning of a legal process. Your defense strategy starts the moment you retain counsel.

An Indictment Is Not a Conviction

Federal healthcare fraud cases are built on paper: billing records, claims data, corporate filings, payor audits. The government has had months, sometimes years, to build its version of events before the indictment ever issued. That does not mean their version is complete, accurate, or unassailable. It means you need an attorney who knows how to take that record apart.

⚖️ Key Legal Point

The government's record is the product of a one-sided investigation. Defense counsel has the right to challenge every document, every inference, and every witness in that record. The paper trail that built the case can also dismantle it.

What the Government Has to Prove Under 18 U.S.C. 1347

The charges in cases like this typically come under 18 U.S.C. 1347. The government does not need to prove a patient was harmed. They need to show that claims were false, that you knew it, and that the intent was to defraud a federal healthcare program. Each of those elements is a target for the defense.

Knowledge. Intent. Falsity. These are not simple boxes to check. They require the government to prove what was in your mind. That is exactly the kind of showing that experienced defense counsel can contest.

Close-up of Medicare billing records, claim forms, and financial ledgers spread across a table under harsh light, representing the paper-based evidence in a federal healthcare fraud prosecution — Federal healthcare fraud cases are built on billing records and claims data. The same record the government built can be contested claim by claim.

The Exposure Is Real. So Is the Range of Outcomes.

Each count of healthcare fraud carries a statutory maximum of 20 years. In a case involving alleged losses of $90 million, the federal sentencing guidelines will push the range high before any other factors are considered. But guidelines are not mandatory. Departures and variances exist.

Cooperation, restitution, loss disputes, role in the offense, and mitigating personal history all factor into where someone actually lands. When cooperation is a possibility, the strategy behind substantial assistance can be the single most impactful factor in the outcome. The difference between a well-built defense and a passive one can be years.

🛡️ Defense Strategy

Federal sentencing guidelines produce an advisory range, not a mandatory sentence. Judges have discretion. Loss amounts, role adjustments, acceptance of responsibility, and mitigating personal history all affect where the final sentence lands. A passive defense leaves those levers untouched.

How the $90 Million Rustamov Case Came Together

According to the DOJ, Rustamov used a shell company to submit thousands of fraudulent claims for durable medical equipment. The equipment was never delivered. It was never authorized by a provider. In many cases, the patients whose information was used never needed it.

That pattern is textbook for how federal healthcare fraud investigations develop: data analytics flags billing outliers, investigators pull the underlying claims, they compare the claims to actual delivery records, and they build a paper case from the bottom up. By the time the indictment issued, the government had already reconstructed the entire scheme on paper. This case is part of a broader DOJ offensive — healthcare fraud charges are surging nationwide, and South Florida remains one of the most aggressive districts for these prosecutions.

🚨 Case Alert

In DME fraud cases, the government compares billing claims against delivery confirmations, provider authorizations, and patient records simultaneously. Gaps at any point in that chain become evidence. If you have operated in the DME space, those records need to be reviewed by defense counsel before the government gets to frame them first.

The Earliest Stages Shape Everything

The first move is retaining experienced federal defense counsel before your arraignment if possible. Every decision made in the early stages, from detention hearings to initial appearances to how you engage with prosecutors, shapes the case that follows.

Statements made without counsel, documents produced without a strategy, and delays in building a defense team all work against you. The government does not slow down because the defense is not ready.

Federal law enforcement agents in dark suits walking through a hallway with documents, representing the enforcement action following a Medicare fraud indictment — Federal enforcement moves quickly after an indictment. Defense preparation needs to start at the same pace.

What Your Attorney Will Be Looking At

Defense counsel in a case like this will be examining the entire paper record the government built. That means every claim file, every authorization form, every delivery log, every shell company filing, and every financial transaction in the alleged scheme.

The question is not just whether fraud occurred. The question is whether the specific defendant who was charged had the knowledge and intent the statute requires, what their actual role was, and whether the government's evidence holds up under cross-examination.

Loss calculations, which drive sentencing guidelines, are also a target. The government's $90 million figure is an allegation. Defense counsel can dispute the methodology, the attribution, and the specific transactions included. Even a significant reduction in the calculated loss amount can meaningfully change the guideline range.

What to Do If You Have Been Indicted

Do not speak to federal agents or prosecutors without counsel present.

Retain experienced federal defense counsel before your arraignment. Not after. Before.

Do not destroy, alter, or move any documents or records. Obstruction is charged separately and makes everything worse.

Do not contact anyone else connected to the investigation: employees, co-defendants, billing staff, anyone. This can become witness tampering.

A federal healthcare fraud indictment is serious. It is also the beginning of a legal process, not the end of one. Outcomes depend heavily on the quality of the defense, the facts in the record, and how early experienced counsel gets involved.

Federal indictment documents and legal paperwork stacked on a desk in a law office, representing the paper-based record at the center of a federal healthcare fraud prosecution

"The government's version of events is not the final one. It is the opening move. Your defense starts by taking that record apart."— Aaron M. Cohen, AMC Defense Law

❓What happens at a federal arraignment for healthcare fraud?

At arraignment, the charges are formally read and you enter a plea. How your attorney handles detention, bail, and initial statements at that hearing sets the tone for everything that follows. Showing up without experienced federal defense counsel is a serious mistake.

❓Can the government really prove intent in a Medicare fraud case?

Intent is one of the hardest elements for the government to establish. They need to show you knew the claims were false and intended to defraud the program. That is a high bar, and it is exactly where experienced defense counsel focuses.

❓Is the $90 million loss figure in the indictment the actual sentencing exposure?

Not necessarily. The loss amount in an indictment is the government's allegation. Defense counsel can dispute the calculation, the methodology, and which transactions are properly attributed to the defendant. Reducing the loss figure can significantly reduce the guideline range.

❓What if I was not the one submitting the fraudulent claims?

Federal prosecutors charge under conspiracy theories that reach everyone with knowledge of or supervisory responsibility over the alleged conduct. Owners, executives, and billing supervisors have all been charged as co-conspirators without personally submitting a single claim.

Federal Healthcare Fraud Defense in Florida

If you or your loved ones have been arrested or are under investigation in connection with a healthcare fraud indictment, call Aaron M. Cohen 24 hours a day to get help.

Aaron M. Cohen, federal defense attorney at AMC Defense Law, seated at a desk reviewing case files in a professional law office, representing focused and experienced federal healthcare fraud defense

AMC Defense Law represents individuals and healthcare entities facing federal fraud investigations and indictments throughout Florida and nationwide.