DOJ Breaks Up $200M Miami Medicare Fraud Scheme

ATC allegedly routinely admitted patients to the PHP program who suffered from Alzheimer?s and dementia and therefore were not eligible for the PHP program because their mental capacity did not allow them to benefit from group therapy.

Prosecutors allege that patient charts and notes from therapy sessions were routinely altered at ATC to make it appear that the otherwise disallowed patients qualified for PHP treatments. The indictment alleges that Duran and Valera told employees and doctors at ATC to alter diagnoses, and medication types and levels to make it appear that the patients qualified for PHP treatments. Prosecutors allege that Valera also manipulated the length of patients? stays to maximize Medicare payments.

The civil complaint and temporary restraining order also name American Sleep Institute Inc. and D&V Development Inc., as participants in the fraud. Civil court documents allege that ASI—owned and operated by Valera and Duran—submitted false claims to Medicare for sleep studies, and that D&V was established to divert funds from ATC and ASI.

"Community mental health centers across the country serve a uniquely vulnerable population," says HHS Inspector General Daniel R. Levinson. "Those attempting to defraud this critically important program—as we are charging here today—should expect to pay a heavy price."

Since its inception in March 2007, Strike Force operations in seven districts have obtained indictments of more than 825 people who collectively have falsely billed the Medicare program for approximately $2 billion.