Twenty people, including three doctors, have been charged in Florida for their part in a $200 million fraudulent Medicare billing scheme, the Departments of Justice and Health and Human Services have announced.
The 38-count indictment, unsealed February 15 in U.S. District Court in the Southern District of Florida, alleges that the defendants worked with and for the American Therapeutic Corporation and Medlink Professional Management Group.
According to court documents, the defendants participated in a scheme to defraud Medicare by submitting false claims for mental health services administered at ATC facilities that were medically unnecessary or not provided at all. The indictment alleges that they paid kickbacks to patient brokers, owners and operators of halfway houses and assisted living facilities in exchange for delivering patients to ATC facilities, and that they participated in an extensive and complicated money laundering scheme related to the cash for kickback payments.
Sixteen of the defendants have been arrested as of press time, and arrests are expected to continue "in the coming days," federal officials said.
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ATC's and Medlink's owners and managers, Lawrence S. Duran, Marianella Valera, Judith Negron and Margarita Acevedo, were originally indicted along with the corporate entities, ATC and Medlink, in October 2010. The latest 38-count indictment charged them with additional offenses, acccording to Justice officials.
"As today's charges reflect, defrauding the Medicare system was not an aberration at ATC, but instead part and parcel of its business operations," said Assistant Attorney General Lanny Breuer of the Criminal Division. "The alleged scheme was brazen in scope and carried out by the company's owners, doctors, marketers and others. By exploiting positions of trust, these defendants masked their fraudulent operation as a legitimate mental health business. These charges are evidence that we will pursue Medicare cheats no matter their position."
HHS Inspector General Daniel Levinson said community mental health centers are an essential element of the nation's healthcare system and serve vulnerable populations.
"Today's arrests by OIG agents and our law enforcement partners show that we will not tolerate criminals who pay kickbacks for referrals of Medicare business or who bill for services that were either medically unnecessary or never provided," he said.
"Community mental health centers can no longer use phantom medical care as a front to bilk Medicare for unnecessary or nonexistent medical services," said FBI Special Agent in Charge John V. Gillies of the Miami field office. "The FBI and our law enforcement partners will investigate and criminally prosecute such fraud to the fullest extent of the law."
Since its inception in March 2007, federal investigators in seven districts have obtained indictments of more than 850 individuals who collectively have falsely billed the Medicare program for approximately $2.1 billion, according to HHS. In addition, HHS' Centers for Medicare and Medicaid Services, working in conjunction with the HHS Office of the Inspector General, is taking steps to increase accountability and decrease the presence of fraudulent providers, federal officials said.
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