The Justice Department Wednesday arrested 52 people for their alleged role in a $163 million, 25-state Medicare fraud scheme, the agency said. Authorities say it is the “largest Medicare fraud scheme ever perpetrated by a single criminal enterprise.”

The defendants are alleged members of an Armenian organized crime outfit operating largely out of New York and Los Angeles. The group “stole the identities of legitimate doctors and filed applications to bill Medicare in the names of these doctors,” according to a Justice Department press release. During the time of the scam, the defendants allegedly operated at least 118 phony clinics in 25 states.

Though the defendants had billed Medicare for roughly $163 million, only $35 million was paid out, according to the Justice Department. The agency became suspicious when the defendants submitted obviously bogus claims, including a phony eye doctor billing for bladder tests, a phony ear, nose and throat specialist seeking reimbursement for pregnancy ultrasounds, and a forensic pathologist billing for office visits.

If convicted, the defendants—including Armen Kazarian, who is alleged to be a “Vor,” the Armenian equivalent of a mafia “Don”—could face life imprisonment and millions of dollars in fines.