Dozens arrested in Medicare mental health fraud

[Judi Lynn]

Source: Miami Herald

Posted on Wednesday, 09.07.11
Dozens arrested in Medicare mental health fraud

By Jay Weaver
[e-mail]

Federal agents have arrested dozens of suspects charged with bilking Medicare of hundreds of millions of dollars in bogus services for mental health therapy and other types of healthcare.

Agents with Health and Human Services and the FBI have fanned out across three South Florida counties, arresting clinic owners, healthcare employees, patient recruiters and assisted living facility owners who allegedly supplied hundreds of patients to the mental health clinics.

The sweep comes after the indictment of Miami-based American Therapeutic Corp., which was charged along with 24 employees and others over the past year. That case alone involved $200 million in false claims submitted to the federal healthcare program for the elderly and the poor.

American Therapeutic's top executives and others have been convicted in recent months. The latest sweep entails clinics offering group therapy sessions, home healthcare, HIV services and medical equipment.

Read more: http://www.miamiherald.com/2011/09/07/2394354/dozens-arrested-in-medicare-mental.html

---

Earlier details from previous story in Miami, long the center of US Medicare fraud:
Posted on Tuesday, 08.23.11

Jury convicts Miami woman of Medicare fraud involving mental-health clinics

A federal jury convicted a business woman who conspired with the owners of a Miami-based mental health chain in a scam to bilk Medicare of $200 million.
BY JAY WEAVER
[e-mail]

A business woman accused of conspiring with the owners of a Miami-based company in the nation’s biggest mental-health billing racket was convicted of defrauding Medicare Tuesday by a federal jury.

Judith Negron, 40, of Hialeah, served as vice president of a subsidiary of American Therapeutic Corp., a seven-clinic chain that billed Medicare $200 million for group mental health sessions that were either unnecessary or not provided to patients.

Some people, suffering from dementia and Alzheimer’s disease, could not have benefitted from the treatments.

Negron ran MedLink Professional Management Group, which Justice Department prosecutor Jennifer Saulino said was set up solely to launder $83 million in Medicare payments to American Therapeutic’s owners, employees and others who participated in the scheme over the past decade.

More:
http://www.miamiherald.com/2011/08/23/2372008/jury-convicts-miami-woman-of-medicare.html

~~~~~
4 arrested in alleged $200 million Medicare fraud case
By Jay Weaver, The Miami Herald
Thu, 10/21/2010 - 12:29pm

MIAMI -- Federal agents arrested four Miami-Dade health care operators Thursday in one of the nation's biggest Medicare fraud cases, charging them with scheming to fleece $200 million from the taxpayer-funded program by billing for bogus mental health services.

Lawrence S. Duran, 48, of North Miami, and his company, American Therapeutic Corp., were charged along with other employees in a conspiracy indictment. The Miami-based company's chief executive officer, Marianella Valera, 39, was also among the defendants named in the indictment.

Duran, Varela and two other employees -- Judith Cruz Negron, 39, and Margarita Acevedo, 40 -- were in federal custody Thursday morning.

The indictment was unsealed at the same time as a government whistle-blower lawsuit filed against American Therapeutic, the nation's largest chain of community mental health centers licensed by Medicare, authorities said.

More:
http://www.standard.net/topics/fraud/2010/10/21/4-arrested-alleged-200-million-medicare-fraud-case

[rfranklin]

1. More Republicans apprehended!

Are they incorrigible like sex offenders and Catholic priests? Or can they be reformed?

[SpiralHawk]

2. Republicon Family Business Values

As usual. The bottom of the cesspool.

They ripoff & trash America's medical system, then whine that it sucks...

[InkAddict]

3. Job creators, indeed--7 clinics plus other services--set up

Documented patient encounters? I suppose ALL were "making progress" (or not)?

So, "What do you think about that?"

[greymattermom]

4. how about cure the gay therapy

will that be considered fraud?

[David Sky]

8. Would love to see a few of those shut down, Michele B's husband for one....

He would need to go out and find a real job.

[L0oniX]

5. Stupid people. Work for Wallstreet ...it's much safer.

[ThomCat]

6. Because of monsters like these people

Politicians are in an uproar, creating a consensus that Medicare is bloated, and needs to be "reformed." Which means, cut, cut, cut, and cut some more.

You know damned well that when they send their investigators in there looking for medical billing fraud it's not going to be the corporations they are going to concentrate on. Corporations have lawyers, and fight back.

They are going to scour and scrutinize every possible medical bill that comes in from Individuals.

It is going to be seniors, and people with disabilities, like me, who depend on Medicare who will be audited again and again and again because corporations keep finding ways to cheat the system out of hundreds of millions of dollars through fraud.

Both of the insurance companies I have to deal with already send nurse practitioners once a year (each)to my house, trained to detect whether or not a client is truly disabled and truly has the medical conditions their file indicates they have. They're paranoid that somehow a client may have miraculously become cured of a disability and didn't tell them.

Of course, they're sending her to interview me "for my convenience" because perhaps after I spend those two hours explaining to her everything she should already know from reading my medical records "she can discuss your needs with your doctors to ensure that you are receiving the care and services you need." As if my doctors don't already know exactly what care and services I need? :eyes:

The fraud paranoia is already out there, and it's not aimed at corporations. It's targeting people with disabilities first. But it's going to spread to seniors next. Just watch.

It's annoying having their snoops sent into my home twice a year. It's insulting that they lie to me about it and claim that they're doing it to help me. I really hate insurance companies. x(

[NBachers]

7. Are Jeb Bush's dirty hands all over this one, too?

http://www.informationclearinghouse.info/article3335.htm

[Judi Lynn]

10. Jeb's Cuban "exile" pal, Miguel Recarey,got away with the largest Medicare fraud in history. Dirty.

TRUST OR HUSTLE: The Bush Record
David E. Scheim

~snip~
JEB BUSH. In 1987, Miguel Recarey, a longstanding business associate of Tampa Mafia boss Santos Trafficante, fled the U.S. under three indictments for labor racketeering, illegal wiretapping, and Medicare fraud.1 His firm, International Medical Centers (IMC), which was America’s largest health maintenance organization for the elderly and which had received $1 billion in Medicare funds, collapsed.2 Recarey’s HMO left $222 million in unpaid bills,3 and was suspected of up to $100 million in Medicare fraud.4 “IMC is the classic case of embezzlement of government funds,” said William Teich, who headed the U.S. Office of Labor Racketeering in Miami. Teich called it a “bust-out operation” where money was “drained out the back door” and disappeared down “a black hole.”5

But in 1985, Recarey had faced a major obstacle to building his Medicare empire: a Department of Health and Human Services (HHS) regulation that restricted an HMO to drawing no more than 50% of its revenue from Medicare.6 Jeb Bush came to the rescue: he called both HHS Secretary Margaret Heckler and a top aide, C. McLain Haddow and successfully convinced them to waive the regulation for Recarey, Haddow testified to Congress.7 Bush’s lobbying of HHS took place during the same period that top-level Republican lobbyists whom Recarey had hired for $1 million were also courting HHS for the waiver.8 Bush said that said he did not recall making any calls to Heckler or Haddow, but confirmed that he made one call on Recarey’s behalf to Haddow’s assistant, to secure Recarey a “fair hearing” within HHS.9

Haddow added in a news interview that in November 1984, Jeb had also called Heckler and Haddow for Recarey about another problem - complaints to HHS from doctors and patients about IMC’s medical care and allegations that Recarey had embezzled funds a few years earlier from another hospital.10 Bush had told Haddow that “contrary to any rumors that were floating around concerning Mr. Recarey, that he was a solid citizen from Mr. Bush’s perspective down there (in Miami), that he was a good community citizen and a good supporter of the Republican Party.”11

In 1986, the year after he successfully lobbied HHS to allow Recarey’s Medicare business to grow ultimately to a total of $1 billion, Jeb Bush’s small real estate firm received $75,000 from Recarey’s HMO for the purpose of finding it a new headquarters.12 Bush said that the payment was unrelated to his lobbying for Recarey.13 But Bush never did actually locate a headquarters for IMC, and the record suggests that the HMO had already selected the headquarters it ultimately moved into when it hired Bush.14 Jeb confirmed that he received $75,000 from Recarey without closing any real estate deals.15

More:
http://www.campaignwatch.org/more1.htm

~~~~~

http://thepete.com.nyud.net:8090/uploads/thepete20030505d.jpg

Bush family friend, major criminal, Miguel Recarey.

[ninehippies]

9. health care fraud

My experience as both self-paying patient and one who has received state help with medical care: it's not the people receiving medical care that are the problem, it's the middle men. Once as a self-payer, I was charged $10. for a small tube of vaseline. Who sees the real cost when insurance 'pays' for it? Recently I had to question some additional charges on a state-covered eye exam for my daughter. And then someone tried to steer me toward pricier frames since the state was covering costs. It's the contracted businesses that are bilking the government health providers, not the recipients of care.

[dipsydoodle]

11. BBC News link

Ninety-one people, including doctors and nurses, have been charged with making fraudulent US Medicare claims totalling $295m (£185m).

Some of the 91 are said to have billed the US government for health services to people who had already died.

Arrests were made in eight US cities, Attorney General Eric Holder said.

http://www.bbc.co.uk/news/world-us-canada-14831292

[alp227]

12. Wash. Post: 91 charged with Medicare fraud across U.S.

The Obama administration escalated its crackdown on health-care fraud Wednesday, announcing charges against 91 people in eight cities who are accused of bilking the Medicare system out of nearly $300 million and victimizing the elderly and disabled people who rely on the federal insurance program.

Among those charged in the coordinated series of arrests was a doctor in Detroit who allegedly billed Medicare for services provided to dead people and claimed that he performed psychotherapy treatments more than 24 hours a day. Other doctors, nurses and health-care company owners were charged in various schemes to get paid for services that were medically unnecessary or never provided, officials said.

full: http://www.washingtonpost.com/politics/91-charged-with-medicare-fraud-across-us/2011/09/07/gIQApV7DAK_story.html

[Judi Lynn]

13. Medicare fraud case nets dozens of arrests

Posted on Wednesday, 09.07.11
Medicare fraud case nets dozens of arrests

Federal agents busted 42 South Florida suspects on Medicare fraud charges as part of a Justice Department sweep targeting hotspots from Miami to Los Angeles.

By JAY WEAVER
[e-mail]

The out-of-state patients, suffering from disabilities and addictions, were lured to South Florida with the promise of a roof over their head.

But once they arrived, with their valuable Medicare cards in hand, they would be squeezed into rundown assisted-living facilities and steered to purported mental-health programs -- at a multimillion-dollar cost to taxpayers, authorities say. If they dropped out of the group therapy sessions, the ALF owners would toss the patients out into the street.

“They were down on their luck,” U.S. Attorney Wifredo Ferrer said, explaining how the latest Medicare scam would target patients from the Southeast. “Come on down, have a fresh start in Miami. But there was a catch.”

On Wednesday, Ferrer announced that federal agents arrested 42 suspects on Medicare fraud charges in South Florida, including the owners of Biscayne Milieu Health Center, a Fort Lauderdale psychiatrist who referred patients to the Miami Gardens clinic, patient recruiters and ALF landlords. Other defendants were operators of home healthcare agencies, HIV-therapy clinics and medical equipment businesses.

More:
http://www.miamiherald.com/2011/09/07/2394354/dozens-arrested-in-medicare-mental.html

[demgrrrll]

14. Florida, Texas and Louisiana. Interesting. n/t