20 Indicted in $200M Florida Medicare Fraud Investigation

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.

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.

(1) Comment so far...

  1. As a physician I believe that physicians that defraud the people of the United States should be treated as traitors. The USA is in financial turmoil and those making it worse are for their own gains are obviously not true citizens of our country but rather white collar terrorists. This is true in my mind for all white collar perpetrators of fraud and should have the same consequences as traitors.
    As a physician I also see why people are not having the respect for us as they once did. It is bad enough that they see us bowing down to lawyers, pharmaceutical corporations,the FDA and now the suspicion that we are also thieves. It will be interesting to see what the punishments rule on these culprits and also some articles by the AMA and Medical associations would be interesting and appropriate.
    Alan J. Sault MD, ABHM

Let us know your thoughts:

By clicking "submit" below, you are agreeing to abide by our comment policy here.

Wish your picture would appear next to your comments here? Upload a picture at Gravatar to make it happen. It's that simple.

Let us show you the goods.

The more we know about each other, the better. Let’s schedule a time to meet and we’ll customize a demo that will reflect the way you practice medicine.

* indicates a required field

Interested in a quote? Let’s get to know each other first.

We’re not for everyone. Let’s schedule a time to talk and find out if we are a fit for you. Then we’ll be able to provide a quote customized for your practice. Let us know the best way to get in touch with you and we’ll make it happen.

* indicates a required field

Is It Worth It?

Why wait for stimulus funding? Calculate your Return on Investment (ROI) today!

What is your Return on EHR?

There are several components to calculating your return on investment (ROI).

There is a revenue side, allowing you to capture charges more accurately, code correctly and reduce payor rejections. There also exist many expense savings, including reduced paper supplies, transcription costs, space savings, and staff efficiency.

If you look at the ROI only as a physician, you may miss the ROI available to you as a business owner… remember, in many cases you are BOTH.

Estimate your Annual Savings with EHR

Try our quick ROI calculator and find out if an EHR may be financially beneficial for you. You’ll get your answer PDQ.

Our formula takes into account industry averages and best practices from various sources, but we’re happy to personalize it for you.

Want more detailed information on savings? Just ask. That’s what we’re here for.

Try our ROI Calculator to determine the
impact our EHR will have on your business:

  • For a more detailed savings breakdown,
    please enter your info below

    * indicates a required field

    Relevant. Interesting.
    Always Fresh.

    Weekly updates from us on the latest EHR news and information to help you navigate the quickly changing world of health care.

    * indicates a required field

    Everyone's doing it.

    Chances are you heard about us from a friend. People like to talk. Keep spreading the word.

    * indicates a required field