Two Florida Corporations, American Therapeutic Corporation (ATC) and Medlink Professional Management Group Inc., pleaded guilty to a Medicare fraud scheme of $200 million according to the Departments of Justice and Health and Human Services (HHS) announced.
ATC operated partial hospitalization programs (PHPs) in seven different locations throughout Florida. A PHP is a form of intensive treatment for severe mental illness. Medlink operated as a "management company” for health care businesses. In reality, ATC and a related company, the American Sleep Institute (ASI), were Medlink’s only clients.
ATC and Medlink are each charged with conspiracy to commit health care fraud in a superseding indictment unsealed on Feb. 15, 2011. ATC is also charged with health care fraud and conspiracy to defraud the United States and to pay and receive illegal health care kickbacks.
Lawrence Duran, 48, and Marianella Valera, 39, owners of American Therapeutic Corp., were indicted back in October and 22 others -- including company employees, psychiatrists and patient recruiters -- have also been charged.
U.S. Attorney Wifredo Ferrer for the Southern District of Florida, stated the following:
The defendants altered patient files, diagnoses and medication types and levels to make it appear that patients being treated qualified for PHP treatments. This was done so that the defendants could fraudulently bill Medicare for more than $200 million in medically unnecessary services. We are pleased to have put these unscrupulous operators out of business.”
Special Agent in Charge John V. Gillies of the FBI’s Miami Field Office was on target when he stated the following:
“No matter what the scheme or how elaborately it was disguised, personal and corporate greed by these two corporations and their owners defrauded taxpayers of millions of dollars. Ultimately, health care fraud robs from the elderly and disabled.
As indicated in this case, fraud is usually not accomplished alone. It takes one to mastermind and several players to make it work. This is how a whistleblower comes across information that his company is engaging in fraudulent practices.
Since March 2007, thanks to the valiant efforts of the Medicare Fraud Strike Force, over 1,000 defendants who collectively have billed the Medicare program for more than $2.3 billion, have been prosecuted on fraud charges.This could not have been done without the combined efforts of whistleblowers and the Health Care Fraud Prevention and Enforcement Action Team (HEAT).
Under the False Claims Act. whistleblowers have an added incentive to report fraud. This Act allows whistleblowers to receive a reward of 15-25% if the government intervenes in the lawsuit. If the government chooses not to proceed, the whistleblower can pursue the case on behalf of the government alone and will be entitled to 25-30% of the governments proceeds in qui tam or false claims cases.
If you are considering bringing a Florida lawyers against a former employer, contact a qui tam attorney to evaluate the strength of the complaint and protect your rights.
Click on the following link to read more on the following links:
Couple pleads guilty to Medicare Fraud - Sun Sentinel
Understanding Qui tam and How the False Claims Act works - Whistleblower Law Blog