Clinic Director Sentenced to 111 Months for $63 Million Health Care Fraud

A former health care clinic director and licensed therapist was sentenced in Miami to 111 months in prison in connection with a health care fraud scheme involving defunct health provider Health Care Solutions Network, Inc., (HCSN).


The clinic director pleaded guilty to conspiracy to commit health care fraud. During the course of the conspiracy, the clinic director was employed as a substance abuse counselor, therapist and clinical director of HCSN’s Partial Hospitalization Program (PHP).  A PHP is a form of intensive treatment for severe mental illness.


HCSN of Florida operated community mental health centers at three locations. During his employment, the clinic director worked full time at all HCSN-FL locations in various capacities.  According to court documents, the clinic director was aware that HCSN-FL paid illegal kickbacks to owners and operators of Miami-Dade County Assisted Living Facilities (ALF) in exchange for patient referral information to be used to submit false and fraudulent claims to Medicare and Medicaid.  The clinic director also knew that many of the ALF referral patients were ineligible for PHP services because many patients suffered from mental retardation, dementia, and Alzheimer's disease.


Court documents reveal that the clinic director was aware that HCSN-FL personnel were fabricating patient medical records. Many of these medical records were created weeks or months after the patients were admitted to HCSN-FL for purported PHP treatment and were utilized to support false and fraudulent billing to government sponsored health care benefit programs, including Medicare and Florida Medicaid.  During his employment at HCSN-FL, the clinic director signed fabricated PHP therapy notes and other medical records used to support false claims to government sponsored health care programs.


HCSN of North Carolina (HCSN-NC) operated one location in Hendersonville, N.C.  At HCSN-NC, the clinic director served as the clinical director and assisted an HCSN owner in obtaining necessary licensing, credentials, and Medicare authorizations for HCSN-NC.  According to court documents, from 2008 through 2009, the clinic director purportedly supervised the therapists within the HCSN-NC PHP, including an unlicensed therapist purportedly performing PHP therapy to HCSN-NC patients.  The HCSN-NC owner and the unlicensed therapist were sentenced to 168 months and 70 months, respectively, in prison.


According to court documents, from 2004 through 2011, HCSN billed Medicare and the Florida Medicaid program approximately $63 million for purported mental health services. This case is being investigated by the FBI and the Department of Health and Human Services’ Office of the Inspector General (HHS-OIG).  The case 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 1,500 defendants who have collectively billed the Medicare program for more than $5 billion.  In addition, HHS’s Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.


See the DOJ Announcement