Eight Italian doctors have been sentenced to prison for carrying out dozens of unnecessary operations for financial gain.
The doctors, who were working at Milan's Santa Rita clinic, carried out more than 80 unnecessary operations.
The surgery included breast and lung removal, La Repubblica newspaper reports.
The clinic's chief thoracic consultant, Pier Paola Brega Massone, was sentenced to 15-and-a-half years for his role.
In sentencing, the judge said Berga Massone was "cruel, malevolent and lacking the slightest sense of human pity".
Massone is reported to have said: "I'm just the scapegoat" when the sentence was read out. His lawyer said he would appeal against the conviction.
Charges against the doctors included voluntary homicide with aggravating cruelty and social security fraud.
In 2005 and 2006 the amount fraudulently claimed totalled some 2.5m euros ($3.4m), according to Agence France Presse.
The Italian media has described the medical centre where according to prosecutors at least five elderly patients died after undergoing invasive procedures as a "clinic of horrors".
According to the city's prosecutors, a total of 83 of the operations that took place between 2005 and 2007 were carried out solely so that the private medical clinic could claim the state subsidy.
In one case, La Repubblica reports, an 88-year-old woman underwent three lung operations - with a payment of 12,000 euros (£10,400) per procedure - when a single operation was all that was medically needed.
In another, an 18-year-old girl underwent a medically unnecessary mastectomy.
A total of 14 people were arrested in connection with the investigation in June 2008. Five of these negotiated plea-bargains, including the clinic's head, Francesco Paolo Pipitone.
Massone and his two assistants - Pietro Fabio Presicci and Marco Pansera, sentenced to 10 years and six years and nine months respectively - have been ordered to pay compensation of up to 80,000 euros (£70,000) to each patient who brought the civil suit, as well as additional fines.