Massive Medicare fraud operation nets millions in Miami

Federal agents crack down on a massive Medicare fraud operation in Miami.

The Christian Science Monitor: "Federal agents in a health-care-fraud strike force moved on Thursday in Miami to shut down a massive Medicare fraud operation that allegedly netted $83 million in illicit proceeds since 2003. Two South Florida health-care companies and four owners and senior managers were named in a 13-count indictment charging fraud and kickbacks. The companies, American Therapeutic Corporation and Medlink Professional Management Group, both of Miami, allegedly worked together in a scheme to bill the Medicare system for community-based mental health services that were either unnecessary or were never actually provided. The ATC case is part of an ongoing push by federal officials to crack down on widespread Medicare and Medicaid fraud. More than 825 individuals have been indicted nationwide by the strike force since its inception in 2007" (Richey, 10/21). 

The Miami Herald: "Even by Miami-Dade's reputation for Medicare fraud, the indictment was a shocker: American Therapeutic's patients could not feed themselves or control their own bodily waste. Many lacked the mental capacity to respond to counseling; instead they simply stared at walls or watched TV. An employee complained that those patients should be ineligible for Medicare since they could not benefit from treatment. She got fired. That launched whistle-blower and criminal investigations that led to the Justice Department's takedown Thursday of Miami-based American Therapeutic Corp., the nation's largest chain of mental health clinics. … At the crack of dawn Thursday, federal agents arrested Lawrence S. Duran, 48, of North Miami, the owner of American Therapeutic; Marianella Valera, 39, the company's CEO; Margarita Acevedo, 40, the firm's marketing director; and Judith Negron, 39, vice president of a subsidiary" (Weaver, 10/22).

The Associated Press / ABC News: "The alleged scam is 'unlike anything we've seen before in terms of the nature and size of the scheme,' said Assistant Attorney General Lanny Breuer. … Authorities are still investigating whether the company actually withheld medication from patients or just doctored the charts. The therapy was supposed to be intensive counseling for patients suffering acute mental illness and are on the verge of hospitalization, but federal officials said ATC didn't give any counseling. Instead, patients were bused in and sat in rooms watching TV and playing games, authorities said" (Kennedy, 10/21).