Psych Crime Reporter

October 17, 2012

Psychologist Vanja Abreu sentenced to 108 months prison in Medicare fraud scam

Filed under: crime and fraud,Medicaid-Medicare fraud,psychologist — Psych Crime Reporter @ 12:38 pm

Vanja Abreu, former program director at the mental health care company American Therapeutic Corporation (ATC), was sentenced Thursday to 108 months in prison for participating in the $205 million Medicare fraud scheme, a press release from the U.S. Attorney’s office said.

Abreu, 49, of Pembroke Pines, worked at ATC centers in Boca Raton and Miami. In addition to her prison term, U.S. District Judge Patricia A. Seitz sentenced Abreu to three years of supervised release following her prison term and ordered her to pay $72.7 million in restitution, jointly and severally with co-defendants.

On June 1, after a seven-week trial, a federal jury in the Southern District of Florida found Abreu, who holds a doctorate degree, guilty of one count of conspiracy to commit health care fraud.

ATC and 20 individuals, including the ATC owners, have all previously pled guilty or have been convicted at trial.

The press release gave this outline of the case:

Evidence at trial demonstrated that Abreu and her co-conspirators caused the submission of false and fraudulent claims to Medicare through ATC, a Florida corporation headquartered in Miami that operated purported partial hospitalization programs (PHPs), intensive treatments for severe mental illness, in seven different locations throughout South Florida and Orlando.

Evidence at trial revealed that ATC secured patients by paying kickbacks to assisted living facility owners and halfway house owners who would then steer patients to ATC. These patients attended ATC, where they were ineligible for the treatment ATC billed to Medicare and where they did not receive the treatment that was billed. After Medicare paid the claims, some of the co-conspirators then laundered the Medicare money in order to create cash to pay the patient kickbacks.

Evidence at trial revealed that Abreu was a program director at ATC’s Boca Raton center from September 2005 to November 2005. In November 2005, Abreu moved to ATC’s Miami center, where she was the program director until February 2009, at which point she was promoted to corporate leadership and oversaw operations at all ATC centers until April 2010.

Evidence at trial revealed that program directors, including Abreu, helped doctors at ATC sign patient files without reading the files or seeing the patients. Evidence further revealed that Abreu and others would assist the owners of ATC in fabricating doctor notes, therapist notes and other documents to make it falsely appear in ATC’s patient files that patients were qualified for this highly specialized treatment and that the patients were receiving the intensive, individualized treatment PHP is supposed to be.

Included in these false and fraudulent submissions to Medicare were claims for patients who were in the late stages of diseases causing permanent cognitive memory loss and patients who had substance abuse issues and were living in halfway houses. These patients were ineligible for PHP treatment, and because they were forced by their assisted living facility owners and halfway house owners to attend ATC, they were not receiving treatment for the diseases they actually had.

Abreu was charged in an indictment returned on Feb. 8, 2011.

ATC executives Lawrence Duran, Marianella Valera, Judith Negron and Margarita Acevedo were sentenced to 50 years, 35 years, 35 years and 91 months in prison, respectively, for their roles in the fraud scheme. The 50- and 35-year sentences represent the longest sentences for health care fraud ordered to date. Acevedo, who was one of the first defendants to plead guilty and has been cooperating with the government since November 2010, testified at the doctors’ trial.

ATC and its management company, Medlink Professional Management Group, pleaded guilty in May 2011 to conspiracy to commit health care fraud. ATC also pleaded guilty to conspiracy to defraud the U.S. and to pay and receive illegal health care kickbacks. On Sept. 16, 2011, the two corporations were sentenced to five years of probation per count and ordered to pay restitution of $87 million. Both corporations have been defunct since their owners were arrested in October 2010.

The case was prosecuted by Trial Attorneys Jennifer L. Saulino, Robert A. Zink and James V. Hayes of the Criminal Division’s Fraud Section. The case was investigated by the Federal Bureau of Investigation and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

Source: Kevin Gale, “American Therapeutics’ program director Abreu gets 108 months,” South Florida Business Journal, October 12, 2012.


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