Psych Crime Reporter

July 25, 2014

Alaska psychiatrist indicted for $300,000 Medicaid fraud

Filed under: Medicaid-Medicare fraud,psychiatrist — Psych Crime Reporter @ 7:35 pm

An Anchorage grand jury indicted a physician Thursday on multiple felony charges accusing him of fraudulently billing Medicaid, tampering with physical evidence and misconduct involving a controlled substance.

Charging documents accuse Dr. Shubhranjan Ghosh, 39, of billing Medicaid more than $300,000 for services he never provided. During Ghosh’s bail hearing in April, reports of a conversation that the doctor had with an employee wearing a wire revealed that the overpayments from the government program may have exceeded $1 million.

The most accurate dollar figure will remain veiled until the state Department of Law releases a completed audit. By Friday, the document had not been made public, said Andrew Peterson, director of the state Medicaid Fraud Control Unit.

Ghosh, a psychiatrist who specializes in mental health services for children, was out of jail on $200,000 cash bail Friday and scheduled to appear in Anchorage Superior Court at 1:45 p.m. Monday. He wears an ankle monitor and cannot leave the city, Peterson said. Peterson said Ghosh is still practicing medicine but cannot bill Medicaid.

The multi-agency investigation into Ghosh’s South Anchorage office began in September. Charges say that Ghosh, a sole practitioner, worked with his office manager to fraudulently bill Medicaid for three years starting in 2010. He made false charges for people including his office manager’s seven children and his ex-girlfriend’s children.

The office manager told an employee that Ghosh submitted false billings to cover time spent on tasks like answering phone calls and writing emails for Medicaid-related cases, services he was not compensated for. The employee estimated the offices submitted five fraudulent bills each week, charges say.

At the April bail hearing, Peterson told the court that Ghosh had a prescription drug problem and wrote multiple opiate prescriptions for friends. Most of the 15 controlled substance charges he faces stem from the delivery of hydrocodone.

Ghosh’s office manager has not been charged but Peterson said the investigation is ongoing.

Since October 2012, the state says, it has ramped up efforts to combat Medicaid fraud and abuse.

Recently, the state uncovered more than $628,000 in alleged Medicaid fraud at Good Faith Services, charging 45 people connected to the personal care provider. In January, the state prosecuted an employee with the Municipality of Anchorage who falsely billed Medicaid for more than $64,000 in personal care attendant services.

Source: Tegan Hanlon, “Anchorage physician indicted for Medicaid fraud topping $300,000,” Alaska Dispatch, July 25, 2014.

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July 8, 2014

Maryland Sukhveen K. Ajrawat indicted for federal health care fraud

Filed under: fraud,Medicaid-Medicare fraud,mental health — Psych Crime Reporter @ 3:13 pm

Greenbelt, Maryland – A federal grand jury has indicted two doctors, Paramjit Singh Ajrawat, age 60, and his wife, Sukhveen Kaur Ajrawat, age 56, both of Potomac, Maryland, on charges of health care fraud in connection with the pain clinic they owned and operated. The indictment was returned on June 24, 2014.

The indictment was announced by United States Attorney for the District of Maryland Rod J. Rosenstein; Special Agent in Charge Robert Craig of the Defense Criminal Investigative Service – Mid-Atlantic Field Office; Special Agent in Charge Nicholas DiGiulio, Office of Investigations, Office of Inspector General of the Department of Health and Human Services; Special Agent in Charge Drew Grimm, Office of Personnel Management, Office of Inspector General; Special Agent in Charge Stephen E. Vogt of the Federal Bureau of Investigation; Special Agent in Charge Bill Jones, of the Washington Regional Office, U.S. Department of Labor – Office of Inspector General, Office of Labor Racketeering and Fraud Investigations; and Special Agent in Charge Paul Bowman of the U.S. Postal Service, Office of Inspector General.

According to the indictment, P. Ajrawat was a licensed physician in Maryland who specialized in interventional pain management. S. Ajrawat was a licensed psychiatrist in Maryland. The Ajrawats owned and operated Washington Pain Management Center (WPMC) located in Greenbelt.

The 16-count indictment alleges that from at least August 2008 through May 2014, the Ajrawats engaged in a scheme to defraud federal health benefit programs including: Medicare, Medicaid, TRICARE, Federal Employees Health Benefits Program and the Office of Workers’ Compensation Programs. Specifically, the indictment alleges that the Ajrawats filed claims for procedures that were not performed (rather, less expensive procedures were performed and then the Ajrawats falsely billed for procedures that provided higher reimbursements), or were not performed in compliance with the requirements for reimbursement.

For example the indictment alleges that the Ajrwats submitted claims that P. Ajrawat had performed an epidural, when instead P. Ajrawat had performed less invasive injections using lidocaine, which was not indicated for epidural use. The Ajrawats allegedly falsely documented the use of an ultrasound machine to direct needle placement in certain patient files and caused the alteration or destruction of patient files to conceal the scheme.

The indictment also seeks the forfeiture of $2,329,109, believed to be the proceeds of the scheme.

The defendants face a maximum sentence of 10 years in prison for each count of health care fraud. An initial appearance has not yet been scheduled.

An indictment is not a finding of guilt. An individual charged by indictment is presumed innocent unless and until proven guilty at some later criminal proceedings.

United States Attorney Rod J. Rosenstein praised DCIS, HHS-Office of Inspector General, OPM-Office of Inspector General, FBI, U.S. Department of Labor-Office of Inspector General, and the U.S. Postal Service-Office of Inspector General for their work in the investigation. Mr. Rosenstein thanked Assistant United States Attorney Kelly O. Hayes, who is prosecuting the case.

Source: “Doctors Indicted For Health Care Fraud,” news release of the United States Attorney’s Office, District of Maryland, June 26, 2014.

January 2, 2013

Owner of chain of mental health centers pleads guilty to fraud

WASHINGTON – The owner of a string of community mental health centers pleaded guilty today in connection with a health care fraud and money laundering scheme involving defunct health care provider Health Care Solutions Network Inc. (HCSN), announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Michael B. Steinbach, Acting Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office.

Armando Gonzalez, 50, of Hendersonville, N.C., pleaded guilty before U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering.  Under the terms of his plea agreement, Gonzalez will also forfeit his interest in property valued at several million dollars, including $987,910 in currency seized in July 2012 as well as several vehicles and properties located in Hendersonville.

According to court documents, HCSN operated community mental health centers (CMHC) at three locations in Miami-Dade County, Fla., and one location in Hendersonville.  HCSN purported to provide partial hospitalization program (PHP) services to individuals suffering from mental illness.  A PHP is a form of intensive treatment for severe mental illness.

According to Gonzales’s plea agreement, HCSN obtained Medicare beneficiaries to attend HCSN for purported PHP treatment that was unnecessary and, in many instances, not even provided.  HCSN obtained beneficiaries in Miami by paying kickbacks to owners and operators of assisted living facilities (ALF).  According to court documents, HCSN routinely admitted patients in Miami who were ineligible for PHP treatment because they suffered from medical conditions – including mental retardation, dementia and Alzheimer’s disease – that could not be effectively treated by PHP services HCSN was purporting to provide.

According to Gonzalez’s plea agreement, his employees routinely fabricated patient census data and patient medical records that were then utilized to support false and fraudulent billing to government sponsored health care benefit programs, including Medicare and the Florida Medicaid program.

Gonzalez pleaded guilty to directing his employees in North Carolina to routinely submit fraudulent PHP claims for Medicare patients who were not even present at the CMHC or on days when the CMHC was closed due to snow.  Similar to HCSN’s Florida operations, patients who were suffering from conditions such as mental retardation were improperly and routinely admitted to HCSN for purported treatment.  To increase its patient base, HCSN Hendersonville employed “marketers” in North Carolina who recruited ineligible patients from surrounding counties.  HCSN would then transport the patients daily and reward them for their attendance by giving them cigarettes.

In furtherance of the North Carolina fraud scheme, HCSN employees and licensed therapists routinely fabricated patient progress notes purportedly documenting intensive mental health therapy.  In reality, patients were crowded into dysfunctional groups that often exceeded more than 20 people. HCSN therapists would then produce bogus therapy notes for sessions that had little therapeutic value and, in many cases, never even occurred.

According to Gonzales’s plea agreement, he was the president of Miami-based Psychiatric Consulting Network Inc., which he used as a shell corporation to launder HCSN health care fraud proceeds.

According to court documents, from 2004 through 2011, HCSN billed Medicare and the Florida Medicaid program approximately $63 million for purported mental health services. The false and fraudulent billing resulted in more than $28 million in payments from Medicare and Florida’s Medicaid programs.

In addition to Gonzalez, former HCSN employees John Thoen, Alexandra Haynes, Serena Joslin and Sarah Da Silva Keller have pleaded guilty to health care fraud and related charges.  ALF owners Daniel Martinez, Raymond Rivero, Ivon Perez and Alba Serrano have pleaded guilty to health care fraud and related charges for their roles in the scheme.  Alleged co-conspirators Paul Layman and Wondera Eason are scheduled for trial on Jan. 14, 2013, before judge Altonaga in the Southern District of Florida.

The cases are being prosecuted by Special Trial Attorney William J. Parente and Trial Attorneys Allan J. Medina and Steven Kim of the Criminal Division’s Fraud Section.  The case is being investigated by the FBI 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: “Leader of $63 Million Mental Health Fraud Scheme Pleads Guilty in Miami,” Department of Justice Office of Public Affairs press release, December 17, 2012.

December 5, 2012

Psychiatrist pays Tennessee $325,000 for alleged overbilled psychotherapy services

Filed under: crime and fraud,Medicaid-Medicare fraud,psychiatrist — Psych Crime Reporter @ 9:29 pm

A Madison psychiatrist will pay the State of Tennessee more than $325,000 for allegedly overbilling TennCare patients for visits, Tennessee Attorney General Bob Cooper announced today.

Named in the agreement is psychiatrist A.K.M. Fakhruddin who is alleged to have overbilled patients for psychotherapy visits. Such practices are illegal under the Tennessee Medicaid False Claims Act. The settlement, which included substantial penalties, represents nearly three times the amount Fakhruddin is alleged to have taken from the program.

An investigation by the TennCare Provider Fraud Task Force revealed that from May 2007 to December 2010, Dr. Fakhruddin billed for extensive 45-50 minute psychotherapy visits when in most cases he was performing brief medication management services with minimal psychotherapy.

“In a few instances, he billed for more than fifteen hours in a day when the actual time spent with patients was a fraction of that amount,” Attorney General Cooper said. “The Task Force takes very seriously the misuse of taxpayer dollars and will continue to work diligently to end such practices. ”

The fraud concerned billings for over 150 patients. The Task Force includes the Attorney General’s Office, TennCare, the Tennessee Bureau of Investigation’s Medicaid Fraud Control Unit and the Office of Inspector General. It is charged with pursuing fraud by any TennCare provider. General Cooper noted, “The Task Force concentrates on every aspect of Medicaid Fraud, which includes not only physicians and drug companies but also mental health services.”

Inspector General Deborah Faulkner stated, “The State of Tennessee is aggressively investigating TennCare fraud and abuse from every angle by working in unison to achieve the overarching goal of protecting taxpayer resources. The cooperation between our Offices is an example of a successful collaboration to stop TennCare fraud.”

Dr. Fakhruddin, who intends to retire and sell his practice, has denied any wrongdoing. There were no allegations of patient harm.

Source: “State Cracks Down on Psychotherapist for Overbilling TennCare,” press release of the Tennessee Attorney General, December 3, 2012.

November 24, 2012

State halts Medicaid payments to psychiatrist Michael Reinstein; federal suit fraud, kickback allegations

Filed under: crime and fraud,Medicaid-Medicare fraud,psychiatrist — Psych Crime Reporter @ 2:19 pm

The Illinois Department of Healthcare and Family Services has suspended Medicaid payments to a controversial Chicago psychiatrist who the federal government says fraudulently prescribed antipsychotic medication to thousands of mentally ill nursing home patients.

The action means that Dr. Michael J. Reinstein, also accused in a federal lawsuit of accepting kickbacks from drug companies, will be prohibited from billing Medicaid, and that any unprocessed bills already submitted will not be paid, said Bradley Hart, Medicaid inspector general.

Hart said the 180-day suspension could be extended pending the status of the federal lawsuit, which was filed last week.

Meanwhile, another state agency, the Illinois Department of Financial and Professional Regulation, has filed a formal complaint against Reinstein that mirrors the federal accusations and could lead to disciplinary action on his medical license. A preliminary hearing is set for Dec. 17.

The two-count complaint alleges that Reinstein “routinely and continuously” prescribed to elderly patients various psychiatric medications, including clozapine, also known by its brand name, Clozaril, despite the risk of potentially life-threatening side effects, including seizures and death.

The “respondent knew and/or should have known that clozapine is considered to be a drug of last resort for elderly patients,” the complaint says.

The complaint also alleges that Reinstein prescribed the treatment in exchange for financial compensation from IVAX, the manufacturer of generic clozapine, and Teva Pharmaceutical Industries Ltd., the company that IVAX later merged into.

Reached by phone Monday, Reinstein, 69, said he was unaware of the payment suspension and couldn’t comment on it. But he said he prescribed the drug appropriately.

“I feel my treatment with clozapine was justified,” he said. “I think for the severely mentally ill population that I treat, the patients I use clozapine with, it was the best choice. I am confident that I will be vindicated.”

He said he will borrow money if necessary to continue his medical practice, which includes working at four hospitals, 20 nursing homes and his office in the Uptown area.

Acting U.S. Attorney Gary Shapiro said last week that the federal lawsuit filed against Reinstein represented “the largest civil case alleging prescription medication fraud against an individual ever brought in Chicago.”

A joint 2009 investigation by the Tribune and ProPublica, a nonprofit investigative journalism group, revealed Reinstein’s unusually heavy reliance on clozapine, which has been linked to at least three deaths. In 2007 he wrote more prescriptions for clozapine than all the doctors in Texas combined, the investigation found. The Illinois Department of Financial and Professional Regulation mentioned the series in its complaint.

In their lawsuit, federal authorities alleged that Reinstein submitted at least 140,000 false claims to Medicare and Medicaid for antipsychotic medications he had prescribed based on the kickbacks he received from pharmaceutical companies instead of the medical needs of his patients.

He also allegedly submitted 50,000 more claims to Medicare and Medicaid in which he falsely stated he had properly monitored the conditions of his patients at more than 30 area nursing homes and long-term care facilities, according to the lawsuit.

The suit seeks triple damages under the False Claims Act as well as hefty civil penalties for each of the tens of thousands of alleged false claims — a total that could easily reach millions of dollars if authorities prove the allegations against Reinstein.

Federal authorities said they are continuing to investigate Reinstein. Hart said his department is assisting them, including calculating the amount of payments for which they may seek restitution.

Source: Deborah L. Shelton, “Watchdog Update: Medicaid payments to psychiatrist halted,” Chicago Tribune, November 20, 2012.

November 7, 2012

Mental health counselor Margie Hollingsworth going to prison for 47 months for Medicaid fraud

Filed under: crime and fraud,Medicaid-Medicare fraud,mental health counselor — Psych Crime Reporter @ 11:00 am

A Lubbock counselor was sentenced Friday to 47 months in prison and ordered to pay more than $556,000 in restitution for making false statements in Medicaid billings.

U.S. District Judge Sam R. Cummings also ordered Margie E. Hollingsworth to pay a $6,000 fine.

Cummings gave Hollingsworth, who still has a counseling practice, a month to help her clients find other counseling services and deal with personal matters before reporting to prison.

She faced a maximum sentence of five years in prison and a $250,000 fine.

Hollingsworth pleaded guilty to one count of making false statements involving health care matters.

A federal grand jury handed down an 18-count indictment in December, including 12 counts of health care fraud and six counts of making false statements.

The case apparently started with a state investigation that led to a Lubbock County grand jury indicting her in October 2010 on one count of Medicaid fraud of more than $200,000. According to court documents, county prosecutors were nearing a trial date when the federal indictment came down.

At that point, the state dismissed its case.

According to the federal indictment, Hollingsworth billed Medicaid for more than $1 million from January 2004 through December 2009, and was paid $576,234, including $556,704 in fraudulent claims.

Hollingsworth and federal public defender David Sloan told Cummings Friday that Hollingsworth’s illegal billings involved seeing clients after they’d used up their 30 annual sessions allowed by Medicaid, or billing for services Medicaid doesn’t cover, such as long-distance telephone services.

“She wasn’t using her patients as an ATM card,” Sloan said.

Hollingsworth, who said she is 62, asked for a suspended sentence so she could keep working to pay off the restitution, because she will have no income while in prison.

She said she still has her counseling license, and said she intended to apply for Social Security and a reverse mortgage to help pay off the restitution.

Source: “Counselor gets 47 months in Medicaid fraud case,” Lubbock Avalanche-Journal, October 19, 2012. 

October 24, 2012

Psychiatrist Nan Beth Alt and physician father face 53 charges each of defrauding Medicaid, Blue Cross

Filed under: crime and fraud,Medicaid-Medicare fraud,psychiatrist — Psych Crime Reporter @ 11:45 am

GRAND RAPIDS, Mich. – A psychiatrist whose Grandville office was raided by the Michigan Attorney General’s office in February and her father now face 53 felonies each.

Nan Beth Alt and her father William Alt allegedly defrauded insurance carriers out of $273,000 by filing improper reimbursement claims from Medicaid, Medicare and Blue Cross Blue Shield.

The Michigan Attorney General’s Office alleges William Alt was treating patients out of a Holland office despite the fact that his medical license was suspended in 2009 and that his daughter helped him by signing blank prescription forms for him, according to documents obtained via the Freedom of Information Act.

In addition to the signed prescription pads found with William Alt, there are accusations that William Alt ordered tests at area hospitals under his daughter’s name, making it appear as though patients were hers rather than his.

The Attorney General’s Office says that Nan Beth Alt’s actions constitute negligence and “lack of good moral character,” “allowing an unauthorized person to use her medical license,” and “fraud or deceit in obtaining or attempting to obtain third party reimbursement,” all of which violate the Public Health Code.

They each face two 10-year felonies and 51 four-year felonies in the Ingham County District Court.

William Alt was also convicted of practicing without a medical license in 2010.

Nan Beth Alt’s license to practice was suspended by the state effective Sept. 6, the documents show. She is scheduled to be in court Nov. 26 after petitioning to lift the suspension.

Source: “Psychiatrist, father face fraud charges, William Alt allegedly practiced without license,” WOOD 8 TV (Grand Rapids, MI), October 23, 2012.

Delaware psychiatrist Yvette K. Baker gets a year in prison for Medicaid fraud

Filed under: crime and fraud,Medicaid-Medicare fraud,psychiatrist — Psych Crime Reporter @ 11:43 am

DOVER – A former Dover area psychiatrist charged with defrauding the Delaware Medicaid Program of nearly $175,000 received a jail sentence Tuesday after pleading guilty to her crimes, Attorney General Joseph R. “Beau” Biden Jr. announced.

Yvette K. Baker, 53, was charged in July, 2011 by the Attorney General’s Medicaid Fraud Control Unit with multiple felony counts of healthcare fraud for the improper billing of the Medicaid Program and prescription drug diversion. The charges, which stem from an investigation initiated by the Medicaid Fraud Control Unit in 2010 after receiving a referral of billing improprieties from the State’s Division of Medicaid and Medical Assistance, cover Ms. Baker’s conduct at the Psychiatric Wellness Center in Dover from July, 2006 through July, 2009.

Following Ms. Baker’s guilty plea she was immediately sentenced by Judge William L. Witham, Jr. to one year in prison, followed by seven years of probation. Additionally, she was ordered to pay $273,000 in damages and fines, including $172,000 to the Delaware Medicaid Program, $100,000 in fines, and $1,750 for the cost of extradition.

Ms. Baker’s license to prescribe drugs was suspended in April, 2010, and her Delaware medical license was suspended in July, 2010.

Ms. Baker was arrested in October, 2011 in Huntsville, Ala. where she resided at the time and was extradited to Delaware in January, 2012. She has been held at the Delores J. Baylor Women’s Correctional Institution in New Castle since her return to Delaware.

“The abuse of prescription drugs is a growing epidemic threatening public health and safety and devastating our families,” AG Biden said. “Prescription abuse in the Medicaid program also increases costs for all who rely on it for their healthcare needs.

“With this case we’re sending a clear message that we’re committed to going after those who improperly prescribe addictive drugs and that we’re committed to cutting waste and fraud to protect this valuable program for all Delawareans.”

Source: “Former Dover psychiatrist jailed after Medicaid fraud sentence,” Delaware State News, October 23, 2012.

Mental health counselor Margie Hollingsworth gets 46 months prison for Medicaid fraud

Filed under: crime and fraud,Medicaid-Medicare fraud,mental health counselor — Psych Crime Reporter @ 11:42 am

Licensed professional counselor Margie E. Hollingsworth, of Lubbock was sentenced today by U.S. District Judge Sam R. Cummings to 46 months in federal prison, following her guilty plea in February 2012 to one count of making a false statement in a health care matter. In addition, Judge Cummings ordered that Hollingsworth pay a $6,000 fine and $556,704 in restitution to Medicaid. She must surrender to the Bureau of Prisons on or before November 23, 2012. Today’s announcement was made by U.S. Attorney Sarah R. Saldaña, of the Northern District of Texas.

According to the factual resume filed in the case, from January 2, 2004 through December 2009, Hollingsworth, an approved Medicaid provider, submitted a claim to Medicare for three hours of face-to-face counseling provided to a patient in Lubbock on Christmas Day 2009, when in fact, she was in Colorado at the time. According to the indictment, during this time period, the total amount Hollingsworth billed for services provided to Medicaid beneficiaries was between $1 million and $2.5 million. Of that amount, Hollingsworth was paid approximately $576,234.39. Of that, $556,704 was paid for fraudulent claims.

The case was investigated by the Texas Attorney General’s Medicaid Fraud Control Unit and the FBI. Assistant U.S. Attorney Amy Burch of the U.S. Attorney’s Office in Lubbock was in charge of the prosecution.

Source: News release of the the U.S. Attorney for the Northern District of Texas, October 19, 2012.

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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