Category Archives: Medicare Coverage

Defendant in American Theraputic Corporation Fraud Case Sentenced to 35 Years

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Judith Negron, who was the 40 year old Marketing Director of Medlink Professional Management Group Inc, was sentenced to 35 years in prison after being found guilty of 24 felony charges related to Medicare Fraud that resulted in over $200 million in fraudulent claims.

Negron, who was associated with the American Therapeutic Corporation(ATC) Medicare Fraud in Palm Beach Florida, which involved paying kickbacks to local assisted living communities for providing Medicare patients to ATC’s mental health clinics. Negron was allegedly one of the higher ups in the Medicare Scam and recieved one of the harshest punishments ever in a Medicare Fraud Case.

Negron was found guilty of 24 felonies that include conspiracy to pay healthcare kickbacks, money laundering, conspiracy to preform money laundering, health care fraud, and conspiracy to commit health care fraud. In addition to 35 years in prison, Negron was also sentenced to 3 years of post-prison probation and a large fine.

The owners of American Therapeutic Corporation, Lawrence Duran and Marinanella Valera, were given similar prison sentences in November, after pleading guilty to Medicare Fraud. Other owners and operators of clinics that participated in the kickback scheme have also plead guilty and been sentenced, like Joseph Williams, the Pompano Beach owner of Avondale Manors Retirement Home. Williams faces 20 years in prison at his sentencing in February.

The Owners of American Therapeutic Corporation, Lawrence Duran and Marinanella Valera, who were sentenced to 50 and 35 years in prison respectively, allegedly used the money earned from their Medicare Fraud to live an extravagant lifestyle, which included a number of expensive cars, traveling, and nice homes on the beach. They were also involved in a romantic manner.

Defendants in Miami ABC Medicare Fraud Case Plead Guilty to Medicare Fraud

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A doctor and two nurses who were involved with the Miami ABC Medicare Fraud scam plead guilty to their roles in a scam that resulted in over $25 million in fraudulent Medicare claims. Each of the defendants plead guilty to one count of conspiracy to commit health care fraud.

The nurses, Luisa Morciego and Eneida Fry, were both sentenced to 2 years in federal prison, in addition to having to pay a fine of around $300,000 and $400,000 in fines respectively. In addition, they will also serve 3 years of probation after their release. The doctor, Jose Nunez, who is 63 years old, was sentenced to 3 years and 3 months in prison, as well as a fine of over $1 million.

According to the plea agreement signed by Nunez, who owned and operated two Miami based medical offices, he provided patients to Florida Home Health Care Providers and ABC Home Health Inc, as well as providing Certificates of Medical Necessity, prescriptions, and other documents required by Medicare to accompany certain types of claims. In most cases, these services were allegedly not needed and often not even preformed. ABC Home Health and Florida Home Health Care provided a number of therapy services, providing kickbacks to doctors and other medical professionals who referred patients to their services.

The fraud perpetuated by Fry, Morciego, and Nunez allegedly took place for 3 years between 2006 and 2009, with over 40 patients being referred to ABC Medical and Florida Home Health Care. The prescriptions and certificates of medical necessity provided by Nunez was responsible for around $1.5 Million.

The nurses, Luisa Morciego and Eneida Fry, were employed by ABC Home medical and allegedly were responsible for falsifying records in order to bill Medicare for services that were either not needed or, in some cases, not preformed. Fry also, according to court records, helped recruit doctors of local home medical clinics to refer patients, who then received kickbacks for their parts in the Medicare Fraud.

Another Guilty Plea in American Therapeutic Corporation Scam

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Yesterday, Joseph Williams, the 41 year old owner of Avondale Manors Retirement Home in Pompano Beach Florida, pleaded guilty to Conspiracy to Commit Health Care Fraud. Williams, who was also involved with Diversified Marketing Group Inc, admitted in court his role in providing Medicare patients in return for a kickback.

The Medicare Scam involved American Therapeutic Corporation(ATC) with Williams receiving $30 per-day per-patient for each Medicare recipient he provided for their mental health care. ATC allegedly offered mental health treatments, which were often not preformed or preformed on people that did not need them.

ATC, who is also associated with the American Sleep Institute(ASI) paid a number of local assisted living facilities for patient information, knowing that the patients did not qualify for the treatment, according to court records. In addition to paying kickbacks to doctors, some patients also received kickbacks as well, which amounted to over $200 million in Medicare Fraud, prosecutors say.

In addition to being involved with the American Therapeutic Corporation and American Sleep Institute medicare scams, Williams also admitted to preforming Medicaid Fraud at his own facility, paying kickbacks to half-way houses and other businesses to receive Medicaid Account Numbers.

Williams, as part of his plea agreement with prosecutors, admitted to his role in this scam, which was responsible for over $2 million in fraudulent claims to Medicare and Medicaid. He is scheduled to be sentenced on February 8th, 2012, where he could face up to $500,000 in fines and 20 years in prison.

As part of the ATC and ASI scams, a number of owners and operators of assisted living facilities, which includes doctors, patients, and therapists have been charged or are awaiting trial.

Miami Man Faces 10 Years in Prison After Pleading Guilty to Medicare Fraud

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Santiago Villa-Restrepo, who is from Miami and around 30 years old, plead guilty to a Detroit based Medicare Fraud Scheme, alleged to have been responsible for over $5 Million in Medicare Fraud. He faces up to 10 years in Federal Prison for his part in the fraud scheme. He pleaded guilty to conspiracy to commit health care fraud.

Allegedly, Villa-Restrepo was involved with recruiting medicare recipients to three Detroit based medical clinics, paying bribes to people for their Medicare Account Numbers.

The Detroit Health Clinics would then bill medicare for unneeded tests or even tests that were not preformed.

Illinois Man Pleads Guilty to Odd Medicare Scam

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Gary Winner, a 49 year old man from Buffalo Grove Illinois, plead guilty last week for an unusual Medicare Scheme that involved shipping penis enlargers to Medicare recipients with Diabetes.

In total, this odd scheme, which took place for 4 years starting in 2005, was responsible for over $1 million dollars. The defendant, as part of his guilty plea, forfeited over $2 million dollars and faces more than 30 years in prison.

Winner, who admitted his part in this scheme, repackaged penis enlargers he bought from adult websites for around $30, claiming that they were used to help with prostate issues, bladder control, urinary flow, and erectile issues.

The penis enlargers original packaging was removed and were placed in plastic bags that included an instruction booklet with falsified information. According to prosecutors, Winner then billed Medicare almost $300 per unit, which netted almost $400,000.

Allegedly, Winner would then use his company, Planned Eldercare, which sold home medical equipment, to target Medicare Patients. Often, through the use of aggressive telemarketing to seniors, Winner would procure Medicare Account Numbers after he provided some free medical equipment federal prosecutors contend.

While Medicare does cover certain types of erectile dysfunction, like other types of Durable Medical Equipment, it must be prescribed by a doctor and required medically. Not only was Winner allegedly misrepresenting his products, he also was accused of purposely shipping medical equipment to patients that they did not need.