EMAIL TO A FRIEND COMMENT

 

Partial Hospitalization Programs Part of Medicare Fraud


On Jan. 28, 2014, a federal grand jury in Miami returned a ten-count indictment charging three Miami residents for allegedly participating in a scheme to defraud Medicare of $190 million by submitting false and fraudulent claims, from approximately December 2002 to October 2010. The first man was charged with conspiracy to pay and receive bribes and kickbacks in connection with a federal health care program, conspiracy to commit money laundering, two counts of money laundering and one count of aggravated identity theft. The second man was charged with conspiracy to commit health care fraud and wire fraud and conspiracy to make false statements relating to health care matters. The third man was charged with conspiracy to commit health care fraud and wire fraud and conspiracy to pay and receive bribes and kickbacks in connection with a federal health care program, as well as two counts of receiving bribes and kickbacks in connection with a federal health care benefit program.

 

According to the indictment, the three men allegedly participated in a scheme orchestrated by the owners and operators of American Therapeutic Corporation (ATC) and its management company, Medlink Professional Management Group Inc. ATC and Medlink were Florida corporations headquartered in Miami. ATC operated purported partial hospitalization programs (PHPs), a form of intensive treatment for severe mental illness, in seven different locations throughout South Florida. Both corporations have been defunct since October 2010.

 

The indictment alleges that the second man was a licensed physician’s assistant who participated in the scheme by, among other things, admitting Medicare beneficiaries to ATC facilities for PHP treatment even though they did not quality for this treatment and falsifying patient records to make it appear as though patients needed, qualified for, and actually received legitimate PHP treatment when they did not. The indictment alleges that the third man served as a patient recruiter who provided ineligible patients to ATC in exchange for kickbacks. The indictment alleges that the first defendant was the co-owner of a check cashing business and that he facilitated the payments of bribes and kickbacks from ATC to various patient recruiters.

 

ATC, Medlink and various owners, managers, doctors, therapists, patient brokers and marketers of ATC and Medlink have pleaded guilty or have been convicted at trial. In September 2011, the ATC owner was sentenced to 50 years in prison for his role in orchestrating and executing the scheme to defraud Medicare.

 

See the DOJ Announcement

 

 

REPRINTS & PERMISSIONS COMMENT