In a surgical clinic in the California desert, what appeared on paperwork as “medically necessary” was more than a mirage. Explanations given to insurers were as phony as the breasts implanted in scores of patients.

The former executive director of The Morrow Institute clinic pleaded guilty Friday in U.S. District Court to a health care fraud conspiracy in which she billed insurance companies between $25 million and $65 million from 2007 to 2011 for procedures that were merely cosmetic. She faces up to 20 years in prison.

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