Category Archives: Medicare Coverage

Four More Convicted in Case Against ATC

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Yesterday, five individuals related to ATC, or the American Therapeutic Corporation, which is located in Miami, where convicted of charges related to their participation in the Medicare scam.

This includes two doctors, who were allegedly instrumental in facilitating the submission of false claims to Medicare, resulting in over $200 million in Medicare Fraud. The case against ATC and related companies is one of the largest known instances of Medicare Fraud.

Doctor Alberto Ayala and Doctor Mark Willner were both convicted of conspiracy to commit health care fraud, while being acquitted of several other charges. They were remanded into custody, awaiting sentencing, while Hilario Morris, a and Curtis Gates, were convicted of similar charges.

However, the jury acquitted a therapist named Lydia Ward and Nichole Eckert, who is a mental health counselor.

Morris, according to court records, paid kickbacks to people who provided medicare recipients that could be used to fraudulently bill Medicare, including owners and operators of Halfway houses. Gates, allegedly received kickbacks for providing patients to ATC’s mental health program.

Prosecutors presented evidence that showed that Ayala and Willner, as well as other doctors related to ATC, routinely signed off on patient records and treatment plans, without ever actually seeing the patients. This is referred to as robo-signing, with evidence presented at the trial showing that some of the forms signed by Willner were when he was on holiday outside of the United States. Allegedly, patients with diseases that would make them completely ineligible for the type of therapy offered by ATC, including people with brain damage, resulting in a persistent vegetative state, were also signed off on by these doctors.

Together, Willner and Ayala were, as per court records, responsible for over a hundred million in fraudulent claims, which represents half of the American Therapeutic Corporation’s medicare scam.

American Therapeutic Corporation, along with a related company, the American Sleep Institute and their parent company Medlink Professional Management, ran a program that provided a special program for those with mental health issues, which is labeled a PHP, or partial hospitalization treatment.

However, many of the patients were not eligible for this type of treatment and the services provided did not actually meet Medicare’s requirements. Kickbacks were paid, instead, by ATC and ASI to a number of half-way house owners and managers, patient recruiters, doctors, and even Medicare recipients themselves, in order to bill Medicare for their mental health treatments.

To date, almost twenty people have been convicted of charges related to the American Therapeutic Medicare Scam. This includes the owners and operators of the company, Margarita Acevado, Judith Negron , Marianella Valera, and Lawrence Duran, as well as those involved with the related parent company, Medlink Professional Management.

Duran was sentenced to fifty years in prison, Valera and Negron both received a 35 year sentence, while Acevado was sentenced to federal prison for over 7 years.

Seventh Family Healthcare Group Representative Sentenced to Prison

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Ezinne Ubani, a nurse in Houston Texas who was involved with the Family Healthcare Group Medicare scam, received a prison sentence of 8 years yesterday.

At Family Healthcare Group, a Texas based in-home care service, Ubani was the head nurse and, as per court records, created reports that she knew to be false, in order to receive payments from Medicare. She was convicted of a single count of conspiracy to commit healthcare fraud.

In addition to her Federal Prison Sentence of eight years, Ubani was ordered to preform three years probation after her release and will, along with her co-defendants, be responsible for a fine of over two million dollars. Three other co-defendants are awaiting sentence for their part in the Family Healthcare Group Medicare fraud, with seven already being sentenced.

Family Healthcare Group provided nursing care to Medicare Recipients and, according to prosecutors, provided kickbacks to patient recruiters for supplying them with eligible Medicare recipients. The representatives of Family Healthcare, allegedly, then created fraudulent patient care plans stating the Medicare recipients required in-home health benefits, even though most of the their patients were not actually in need of this type of advanced nursing care.

The business entity was not previously in good standing in regards to their tax obligations.

Three Sentenced in Miami For Medicare Fraud

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This week in Miami, three individuals related to a home therapy and care service were sentenced to prison, after having been convicted of conspiracy to commit health care fraud last year. The individuals, who operated Nany Home Health Inc were, according to court records, responsible for over fifty million in Medicare Fraud.

The defendants, Robert Gonzalez, Olga Gonzalez, and Fabian Gonzalez were sentenced to 120, 87, and 87 months in federal prison respectively, as well as 36 months of probation after their release. They were also fined forty million dollars, which is expected to be paid as a single fine for all co-defendants.

The owners of this home healthcare business plead guilty to a single count of conspiracy to commit healthcare fraud earlier and, as part of their plea agreement, admitted to attempting to defraud the US Federal Government. They admitted their role in utilizing patient recruiters, who were paid illegal kickbacks for providing Medicare patients to use their service. This included not just physical therapy, but also prescription drug fraud and unneeded medical services.

One interesting difference between this and some of the other common Medicare scams that involve recruiters is that, allegedly, the Gonzalez’s used staffing agencies located in Miami to help provide patients.

Prosecutors contend that many of the patients that received home healthcare services from the Gonzalez’s company were not qualified to receive these Medicare benefits, allegedly falsifying patient records to include symptoms that the Medicare recipient did not actually have.

The Medicare fraud is alleged to have taken place between 2006 and 2009, receiving almost forty million dollars from fraudulent claims they submitted to Medicare.

Nany Home Health is based in Florida and provided services to those on Medicare, including physical therapy and general home healthcare. According to public records, Nany Home Health Inc, which has a Miami address, has been in business for over 15 years, with tax records going back to 1995. Court records indicate that Roberto Gonzalez was the president, Olga Gonzalez was the vice-president, and Fabian Gonzalez was more closely tied to general operations.

Florida Home Medical Business Owners Plead Guilty to Medicare Fraud

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The owners and operators of Serendipity Home Health Inc, a physical therapy and home medical care company located in Miami Florida, plead guilty this week to a single count of conspiracy to commit health care fraud, which allegedly was related to around $20 million in fraudulent Medicare Billings. The fraud, according to prosecutors, took place during 2007 to 2009 and they received approximately $15 million in reimbursement from Medicare.

Allegedly, Reynaldo Navarro and Ariel Rodriguez, who are listed in court documents as the owners of Serendipity Health, paid illegal kickbacks to those who referred Medicare recipients to their home healthcare business. In turn, they were, as per their plea agreements, using this information to bill Medicare for services that were not medically required, including physical therapy. Reynaldo Navarro is 41 years old and Ariel Rodriguez is 37 years old.

According to statements made in court, the patient recruiters also sometimes provided certificates of medically necessity, which are used by Medicare to justify reimbursement for things like wheelchairs or other durable medical equipment, in addition to prescribing unneeded medications that would also be billed to Medicare illegally.

Ariel Rodriguez is listed as the president and registered agent of Serendipity Home Health Inc., which was established in 2006 and is currently listed as Inactive in Florida’s Division of Corporations. Their last annual report was from 2009 and they list a Miami Florida business address in the 33135 zip code.

In addition to Ariel Rodriguez and Reynaldo Navarro, two other employees of Serendipity’s Home Medical Services, Melissa Rodriguez and Ysel Salado, have also been implicated in this case of Medicare fraud. Melissa Rodriguez, who is 24, plead guilty to conspiracy to commit health care fraud last week, on the 28th of March. Salado, who is 26 years old, plead guilty with Reynaldo Navarro and Ariel Rodriguez to the same charge.

Florida Patient Recruiter Pleads Guilty to Role in ATC Medicare Fraud

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Frank Criado, who is 33 and lives in Miami, plead guilty to conspiracy to commit health care fraud, receiving illegal Medicare kickbacks, and defrauding the United States Government for his part in the American Therapeutic Corporation(ATC) and American Sleep Institute(ASI) Medicare Scam.

Criado, who is scheduled to be sentenced at the end of May and could face up to 15 years in prison, as well as a quarter of a million in fines, admitted in court that as a patient broker for ATC and ASI, and their parent company Medlink Professional Management Group INC, he received payments for each day that a patient he referred used ATC’s partial hospitalization program.

Criado, according to court records, was responsible for over seven million in Medicare Fraud, receiving illegal kickbacks in return for recruiting patients for ATC and ASI.

As part of the widespread medicare fraud scam, which was allegedly responsible for more than $200 million in fraudulent claims, patients were enrolled in mental health programs, called partial hospitalization programs, or PHPs. The premise of the programs offered by ATC and ASI was that patients would receive a high level of mental health treatment, with ASI offering sleep tests.

However, the PHPs were typically not medically necessary and not valid mental health programs, with ATC and ASI instead paying doctors, half-way house owners, patient recruiters, and Medicare recipients kickbacks to get Medicare recipients to attend the programs. ATC and ASI, along with their parent company Medlink, would then bill Medicare for the unnecessary and non-qualifying treatments. Kickbacks were paid to referring agents and, in some cases, the actual Medicare patients.

The case against American Therapeutic Corporation and others involved with the scam is ongoing and allegedly involved a large number of individuals in the Florida area. So far, over ten people have plead guilty, with more trials scheduled in April.