20 Charged in $200M Medicare Scam

Three Florida physicians were among the 20 people charged Tuesday in federal court in Miami on healthcare fraud, kickback and money laundering charges for their alleged roles in a $200 million Medicare fraud scheme, federal officials said.

The 38-count indictment unsealed Tuesday in U.S. District Court in the Southern District of Florida alleges that the defendants created and worked with American Therapeutic Corp. and Medlink Professional Management Group Inc., to defraud Medicare by submitting false claims for mental health services that were unnecessary or not provided, according to a joint media release from the Department of Justice, and the Department of Health and Human Services.

U.S. Attorney Wifredo A. Ferrer in Miami said the case shows that Medicare scams have evolved from DME fraud, to infusion fraud, to home healthcare fraud, to community mental health treatment fraud. "Worse yet, healthcare fraud has come to permeate every level of the healthcare industry, from the owners and managers of dirty clinics, to complicit doctors, program directors, therapists, marketers, and patient recruiters," Ferrer said. 

The indictment alleges that the defendants paid kickbacks to patient brokers and owners and operators of halfway houses and assisted living facilities that delivered patients to ATC clinics. The defendants are charged with money laundering related to the cash-for-kickback payments. Sixteen defendants were arrested Tuesday in the South Florida, and more arrests are expected in the coming days.

ATC and Medlink owners Lawrence S. Duran, Marianella Valera, Judith Negron and Margarita Acevedo, were first indicted in October, along with the corporate entities, ATC and Medlink. A superseding 38-count indictment unsealed Tuesday charges them with additional offenses.

Prosecutors said Miami-based ATC operated purported partial hospitalization programs in seven different cities in Florida, from Homestead to Orlando, and that Duran and Valera ran the fraud, kickback and money laundering schemes, Negron abetted them, and Acevedo ran the kickback scheme.

Physicians Mark Willner, MD, Alan Gumer, MD, and Alberta Ayala, MD, were medical directors for ATC, and prosecutors allege that the trio signed false patient charts authorizing unnecessary treatment or continued treatment for patients who were not eligible for PHP treatment, without examining the patients or the charts.

Willner, Gumer and Ayala also allegedly altered diagnoses and medication types and levels to falsely make it appear that the patients qualified for PHP treatments, and manipulated the length of patients' stays in order to maximize the number of days Medicare would pay for the PHP services, prosecutors said.

According to a separate civil complaint, ATC routinely admitted patients to the PHP program who suffered from Alzheimer's and dementia and were ineligible for the PHP program because their mental capacity did not allow them to benefit from group therapy.

The indictments allege that the kickback scheme was supported by a money laundering scheme that issued checks in the names of the defendants or shell corporations they created, cashed the checks and returned the cash to Duran and Valera, who paid the kickbacks. 

In October, the Department of Justice broke up a $200 million Medicare fraud scheme in Miami.

Earlier this month the Office of the Inspector General for the Department of Health and Human Resources posted a list of 'most wanted' Medicare fraudsters.