Guilty Pleas Entered in $200M Medicare Fraud Case

John Commins, for HealthLeaders Media , May 5, 2011

Two South Florida companies entered guilty pleas this week in a Miami federal court for what prosecutors called a "staggering in scope" fraud scheme that falsely billed Medicare for more than $200 million and collected $80 million of the bogus claims, the Departments of Justice and Health and Human Services announced in a joint statement.

The companies were identified as American Therapeutic Corp., the Miami-based operators of seven partial hospitalization programs for the severely mentally ill in South Florida, and Medlink Professional Management Group Inc., which was described by prosecutors as a shell company that abetted ATC's efforts to hide its ill-gained profits, federal prosecutors said.

"The fraud scheme was staggering in scope, and those who concocted the scheme exhibited a complete disregard for the elderly, infirm, and disabled victims who were used to commit it," Assistant Attorney General Lanny A. Breuer of the Justice Department's Criminal Division said in a statement. "These guilty pleas mark an important step forward in our effort to hold accountable everyone -- and every entity -- involved in the scheme, and to recover the maximum amount possible on behalf of American taxpayers."

ATC and Medlink were each charged with conspiracy to commit healthcare fraud in an indictment unsealed on Feb. 15. ATC was also charged with healthcare fraud and conspiracy to defraud the federal government, and to pay and receive illegal healthcare kickbacks, federal prosecutors said.

"The defendants altered patient files, diagnoses, and medication types and levels to make it appear that patients being treated qualified for PHP treatments," said U.S. Attorney Wifredo Ferrer for the Southern District of Florida, in a media release. "This was done so that the defendants could fraudulently bill Medicare for more than $200 million in medically unnecessary services. We are pleased to have put these unscrupulous operators out of business."

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1 comments on "Guilty Pleas Entered in $200M Medicare Fraud Case"

anon (5/25/2011 at 4:26 PM)
One problem with that is that state insurance regulation is ineffective. An example of that is TIG Insurance. TIG Insurance is listed on the database of the State of Colorado Division of Insurance as being active and selling accident and health insurance as well as crop insurance, motor vehicle, and workmen's comp insurance. It gives as an address "2079 Hartwell Lane, Fort Mill, SC 29707". Google-maps shows that address as non-existent. The State of Colorado claims the phone number of TIG insurance is 469-426-4380. That is a Texas number. The State of South Carolina claims TIG's Insurance's "domicile" is California. The State of California lists TIG Insurance as being "active" with an address of "818 W 7th St Los Angeles, CA 90017?. Corporate Wiki lists about 500 corporations at that address. I called the Texas number and spoke to a "Keith Kingman". He said that TIG Insurance stopped selling insurance in 2002 and that all the insurance commissioners know that but they don't update their websites. He said I should call the state insurance commissioners and tell them that TIG Insurance is out of business. But I notified the Colorado Division of Insurance about TIG Insurance many times since 2004.




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