Two Miami healthcare companies and four owners and senior managers of the companies have been indicted on charges of participating in a $200 million Medicare fraud scheme involving mental health services.
A 13-count indictment unsealed in U.S. District Court in the Southern District of Florida charges the American Therapeutic Corporation and Medlink Professional Management Group, along with Lawrence S. Duran, Marianella Valera, Judith Negron and Margarita Acevedo, with one count of conspiracy to commit healthcare fraud.
ATC, Duran and Valera were also charged with 11 counts of healthcare fraud. ATC, Duran, Valera and Acevedo are charged with one count of conspiracy to defraud the United States, to receive healthcare kickbacks and to pay healthcare kickbacks.
The individuals were arrested Thursday morning in Miami and appeared in U.S. District Court that afternoon. Federal agents conducted search warrants at six ATC and Medlink locations.
In a related civil action, a temporary restraining order was obtained to freeze the assets of the indicted companies and individuals.
According to investigators, the defendants sought to defraud the Medicare program by submitting false claims for mental health services administered at ATC facilities that were medically unnecessary or not provided.
ATC, headquartered in Miami, operated supposed partial hospitalization programs – a form of intensive treatment for mental illness – in seven locations throughout Florida, from Homestead to Orlando.
"Since the Strike Force began operation, we have rarely seen anything like the illegal conduct charged in this indictment, both in terms of the nature and size of the scheme," said Assistant Attorney General Lanny A. Breuer of the Criminal Division.
According to investigators, Duran, Valera, Acevedo and ATC paid kickbacks to owners and operators of assisted living facilities and halfway houses for delivering patients to ATC. In many instances, the indictments stated, the patients themselves received a portion of the kickbacks. ATC allegedly billed Medicare for services supposedly provided to the recruited patients.
The civil complaint and temporary restraining order also name the American Sleep Institute and D&V Development. Civil court documents allege that ASI is owned and operated by Valera and Duran and that the company submitted false claims to the Medicare program for sleep studies. D&V Development is also owned and operated by Valera and Duran and was established in an effort to divert funds received by ATC and ASI, court recrds say.
"Community mental health centers across the country serve a uniquely vulnerable population," said Daniel R. Levinson, inspector general of the Department of Health and Human Services. "Those attempting to defraud this critically important program – as we are charging here today – should expect to pay a heavy price."
Since inception in March 2007, Strike Force operations in seven districts have obtained indictments of more than 825 individuals who collectively have falsely billed the Medicare program for approximately $2 billion.