Tag Archives: atc

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.

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.

Another Guilty Plea in Miami American Therapeutic Corporation Medicare Scam

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Sandra Jimenez, who is 38 years old and from Miami, plead guilty yesterday as part of the ongoing American Therapeutic Corporation, or ATC, Medicare Fraud Scheme. She plead guilty to a single count of conspiracy to commit health care fraud and, according to the Department of Justice, was responsible for around $45 million in fraudulent Medicare claims.

As part of Jimenez’s guilty plea, she admitted responsibility for providing kickbacks to assisted living facility owners who provided, typically, unqualified patients for American Therapeutic Corporation’s(ATC) and the American Sleep Institutes'(ASI) partial hospitalization programs, or PHPs.

Jimenez’s worked as a Marketer for these companies, which according to her court statements, entailed locating business owners and those who worked at half-way houses or assisted living facilities, who would be able to refer Medicare patients to her employers partial hospitalization programs. The owners received kickbacks for each day their referred patients stayed in the PHP, which Jimenez has admitted to arranging.

In addition to her work with ATC and ASI, Jimenez also, as part of her guilty plea, admitted to a separate Medicare fraud scheme she was involved with, related to Priority Home Health. In this scheme, Jimenez and others that worked with the Miami based home medical agency, actively recruited Medicare recipients to their company who were not eligible to receive services from the company.

Jimenez sentencing is scheduled for the end of June, June 27, 2012, where should could face up to fifteen years in prison and up to a quarter of a million in fines.

The American Therapeutic Corporation and American Sleep Institute Medicare fraud scam is one of the largest in the company and relied on a large network of doctors, recruiters, and even Medicare recipients, who provided mostly ineligible Medicare patients to receive mental health services. These services would not qualify as partial hospitalization programs and were responsible for more than $200 million in Medicare fraud.

Many defendants have already been tried and convicted in Federal court for their part in this scam, with other trials set for the following months.

The defendants include a wide range of individuals, including those from the parent company, Medlink Professional Management Group Inc.

Broward County Florida Man Pleads Guilty in ATC Medicare Fraud Case

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Today, Barry Nash, who is the sixty-nine year old owner of a Halfway house in Broward County Florida, plead guilty to a single count of conspiracy to commit health care fraud for his part in a Medicare Fraud Kickback Scheme.

Nash’s guilty plea is related to the growing stack of guilty sentences associated with the American Therapeutic Corporation Medicare Fraud scam in Florida.

Nash is scheduled to be sentenced on March 8th, 2012, and faces up to ten years in prison, as well as a fine of up to a quarter of a million dollars.

Nash admitted to receiving kickbacks for funneling patients into a fraudulent mental health shell company operated by American Therapeutic Corporation(ATC) and American Sleep Institute(ASI,) who was related to American Therapeutic Corporation. According to the plea agreement, Nash was responsible for almost a million dollars in Medicare Fraud that was the direct result of patients from his halfway house being sent for treatment at ATC and ASI.

Nash is the most recent in a string of more than 9 individuals convicted of fraud related to ATC. The ATC and ASI fraud involved a large number of doctors, marketers, and even patients in Florida. These individuals received kickbacks for providing Medicare patients to American Therapeutic Corporation, which is related to Medlink Professional Management Group Inc.

Patients were supposed to receive mental health care and treatment, which included a partial hospitalization program(PHP,) but were typically ineligible or did not receive qualifying treatment. In all, the ATC and ASI fraud is believed to have been responsible for over $200 Million dollars in Medicare Fraud.

This prosecution is related to the Medicare Fraud Strike Force, which was formed five years ago to help fight Medicare Fraud. To date, the Health Care Fraud Prevention and Enforcement Action Team, also known as HEAT, and the Medicare Fraud Strike Force has helped prosecute over 1000 defendants, who are allegedly responsible for close to $3 Billion in Medicare Fraud.