How to scam Medicare out of $83 million

How to scam Medicare out of $83 million
A meeting to discuss strategy.

The Feds busted two South Florida companies, American Therapeutic Corporation (ATC) and Medlink Professional Management Group, who allegedly bilked $83 million by deceiving Medicare.

The companies worked together to bill Medicare for unnecessary services or services they never provided.

"It can come as no surprise that the number of consumers who are in need of some type of treatment for either emotional or behavioral disorders has reached alarming proportions." – From the ATC website.

Authorities so far have found only $7 million in assets. Authorities believe there may be accounts and property in Switzerland, Cuba, and the Dominican Republic.

How to scam Medicare out of $83 million
Marianella Valera, CEO and President, from the company’s website.

Those arrested:  Lawrence Duran, Marianella Valera, Judith Negron, and Margarita Acevedo.

How did they do it?

"Sadly these disorders negatively affect their thinking, feeling, and judgment with enormous adverse personal and societal consequence."

The company paid money (to assisted living facilities and halfway houses) to provide patients to go to the company’s group mental health sessions. 

"On a brighter note, American Therapeutic Corporation has placed itself in a position to provide a wide range of behavioral services, therapeutic educational services and social services to address the needs of these consumers."

However, some of the patients could not participate in group mental health sessions because they had Alzheimer’s disease or severe dementia. Employees complained about patients who should not be in group therapy because they could not feed themselves, or they had no bowel control.

One employee said some of these patients were not eligible and she discharged them. She was fired, and the patients were readmitted.

"As an existing service provider, American Therapeutic Corporation is poised to extend services beyond assessment to include crisis intervention, intensive therapeutic outpatient services, diagnostic evaluation, outpatient therapy, partial hospitalization program and family support."

Employees were also told that when writing notes on patients, they should pretend the patient had sleep problems, so the patients could be referred to a related business, the American Sleep Institute, for tests.

Of course, those tests were also reimbursed by Medicare. 

The company also created bogus medical records, faked patient symptoms, forged physician signatures, made up psychiatric evaluations, and said that treatments were given when they were not.

And all the fraudulent bills were paid by Medicare.

"American Therapeutic Corporation has been providing behavioral health services in Dade, Broward and Palm Beach County for over five years."

Of the two defendants pleaded guilty, Marianella Valera was sentenced to 35 years in prison and Lawrence Duran was sentenced to 50 years.

American Therapeutic Corporation website, which may not remain active for very long>>
Medicare fraud case in Florida, Christian Science Monitor>>

New source:
A Miami mental-health executive was sentenced to 35 years in prison on Monday for her role in a $205 million healthcare fraud scheme. Reuters>>

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