Thursday, December 08, 2011

Health Care Owners Sentenced To 50 Years

$87 Million Restitution Ordered By Judge - Longest Sentences Ever In Medicare Fraud

The owner of a fraudulent Miami-area mental health care company, American Therapeutic Corporation (ATC), was sentenced today to 35 years in prison for orchestrating a $205 million Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Judith Negron, 40, was sentenced by U.S. District Judge James Lawrence King in the Southern District of Florida. Judge King ordered Negron to pay more than $87 million in restitution, jointly and severally with her co-defendants. Negron was also sentenced to three years of supervised release following her prison term. 

Two other owners of ATC, Lawrence Duran and Marianella Valera, were sentenced in September 2011 to 50 and 35 years in prison, respectively, for their roles in the scheme. These sentences are the three longest prison sentences ever imposed in a Medicare Fraud Strike Force case.

On Aug. 24, 2011, after a six-day trial, a federal jury in the Southern District of Florida found Negron guilty of 24 felony counts, including conspiracy to commit health care fraud, health care fraud, conspiracy to pay and receive illegal health care kickbacks, conspiracy to commit money laundering, money laundering and structuring to avoid reporting requirements.

Evidence at trial demonstrated that Negron, along with Duran and Valera, masterminded and executed a scheme to defraud Medicare beginning in 2002 and continuing until they were arrested in October 2010.

Evidence at trial established that the three owners submitted false and fraudulent claims to Medicare through ATC, a Florida corporation headquartered in Miami that purportedly operated partial hospitalization programs (PHPs) in seven different locations throughout South Florida and Orlando. 

Negron and her co-conspirators also used a related company, American Sleep Institute (ASI), to submit fraudulent Medicare claims.

According to the evidence at trial, Negron, Duran, Valera and others paid bribes and kickbacks to owners and operators of assisted living facilities and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and ASI. In some cases, the patients received a portion of those kickbacks. 

Throughout the course of the conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries, who did not qualify for PHP services, to attend treatment programs that were not legitimate PHP programs, so that ATC and ASI could bill Medicare for more than $205 million in unnecessary or illegitimate services.

Evidence at trial demonstrated that Negron signed kickback checks to patient recruiters whose only jobs at ATC were to provide patients from halfway houses or assisted living facilities. Evidence at trial also established that Negron and others caused the alteration of patient files and therapist notes for the purpose of making it falsely appear that patients being treated by ATC qualified for PHP treatments and that the treatments provided were legitimate PHP treatments. 

Negron has been in federal custody since her conviction. A top manager, Margarita Acevedo, was sentenced in September 2011 to 91 months in prison.

No comments:

Post a Comment