A little later, the vans would leave Skid Row bound for one of the three hospitals. Some of the homeless people would receive medical treatments, court papers said, whether they needed them or not.

Investigators said recruits often received no medical care at all, or in some cases received faulty health care, as in the case of one person, identified as Recruit X, who court papers said was “given a nitroglycerin patch for her non-existent cardiopulmonary condition.” The treatment caused a dangerous drop in blood pressure that made her ill, investigators said.

She was recruited repeatedly, court papers said, and for her cooperation was paid money that she used to buy crack cocaine.

After the trips to the hospitals, vans dropped off their recruits at the same Skid Row street corners, court papers said.

Those accused of being involved in the alleged scam billed Medicaid and Medi-Cal for thousands of fake treatments, according to lawsuits filed by the Los Angeles city attorney, Rocky Delgadillo, and Thomas P. O’Brien, the United States attorney for the Central District of California. According to the lawsuits, Los Angeles Metropolitan, City of Angels and Tustin hospitals paid Mr. Mitts $1,600 to $20,000 a month and paid salaries to patient recruiters he managed.

Mr. O’Brien said the private hospitals were trying to keep beds occupied at the expense of taxpayers.

Although Medicare scams are relatively common, Mr. O’Brien said they usually implicated small clinics or doctors’ offices. The scale and duration of this enterprise is unusual, investigators said.