Medicare scams come in varied sizes, but William Hlushmanuk's was one of the more industrious.
The Northeast Philadelphia man had little training when he launched an ambulance service and went to dialysis centers to recruit passengers, sometimes right in the waiting rooms. Most weren't medically eligible for a ride - they were able to walk or drive - but no one really checked.
Three times a week, Hlushmanuk's staff would shuttle patients for treatment, then bill the government. In five years, he soaked Medicare for $5.4 million, spending it on motorcycles, drugs, a house, a souped-up Hummer, and trips to Las Vegas and Florida.
On Tuesday, a judge sentenced Hlushmanuk to 92 months in prison, ending a case he said highlighted how rampant such fraud had become and how much it hurt taxpayers.
"In terms of defrauding the government under Medicare, this case ranks way up there," said U.S. District Judge John R. Padova, acknowledging the government had little chance of recouping the money.
Even Hlushmanuk's lawyer told the judge he hoped the case was a wake-up call for Medicare administrators.
"It's too easy for this kind of situation to occur," said Robert Mozenter. "I think the government has to be more diligent . . . and they should try to plug up the holes."
Hlushmanuk, a 35-year-old who introduced himself as "Bill Le" to the judge, once seemed on a legitimate path to a career in emergency services.
After emigrating with his family from Ukraine, he graduated from Northeast High School, became a naturalized citizen, and began training as an emergency medical technician and responder.
But state Health Department officials rejected his bid to start his own service, citing his convictions for attempted burglary and trying to get a gun.
In 2006, Hlushmanuk paid $60,000 to an acquaintance, identified in court papers as Roman Bayger, to act as the applicant for the new service, which he called Starcare.
Bayger was the straw buyer, but Hlushmanuk and his wife, Diana, were the real operators, Adam L. Small, a Justice Department trial attorney who prosecuted the case, told the judge.
Small said Hlushmanuk created the required forms that fraudulently said the patients were medically unfit to transport themselves. He even had some signed by unsuspecting doctors.
The transport service used four or five ambulances and was reliable, the prosecutor said, and Hlushmanuk was "quite good" at recruiting riders.
But he paid his staff paltry wages - their checks even bounced sometimes - and he got hooked on "drugs, women, and the fast life," his lawyer said.
Besides his motorcycles, cars, and trips, the money paid for a house Hlushmanuk and his now-estranged wife bought in Southampton, Bucks County.
Small declined to say how the case landed in the hands of the FBI and the Inspector General's Office from the U.S. Department of Health and Human Services. Mozenter, the defense lawyer, said he believed that it started with a tip to state officials.
Hlushmanuk was indicted last year and pleaded guilty in February to two counts of health care fraud.
"I'm sorry for everything that happened," he told the judge, pledging to get on a better path in prison. "I really didn't know what was wrong or right."
His estranged wife and Bayger also pleaded guilty to charges and are scheduled to be sentenced in July.
Padova said he hoped the case and his sentence might cause others to think before embarking on such schemes. Medicare fraud, he said, "is a social evil, which everyone is trying so hard to control."