Read the Medicare rules and you will quickly learn that Medicare does not pay for treatment outside the US except under very strict language which sometimes grants coverage to short term travelers for specific reasons. Anyone who is submitting anything else to Medicare for payment would have it denied. Of course if the paperwork indicated the procedure was actually performed in the US, when it wasn't, might well slip by for a time. If you are smart you don't want to be anywhere near anything like this when the trap springs shut. Allowing something illegal to continue after it has been discovered is a common tactic. Gathering substantial proof is one reason and following the chain up to the highest levels is another. But you sound like someone who is interested in finding ways to get around rules so it won't be hard for you to learn who is involved When you write "can somehow provide services under Medicare" you already know it ain't evactly kosher. Good luck.