June 12, 12

NEWS / Miami-Area Resident Sentenced to 46 Months in Prison for Participating in Medicare Fraud Scheme

WASHINGTON—A Miami-area resident who helped pay illegal kickbacks and transported ineligible patients to a fraudulent mental health company was sentenced today to 46 months in prison for her role in a scheme to falsely bill Medicare, announced the Department of Justice, the FBI, and the Department of Health and Human Services (HHS).

Leyanes Placeres, 32, was sentenced by U.S. District Judge Patricia A. Seitz in the Southern District of Florida. In addition to her prison term, Placeres was sentenced to three years of supervised release and was ordered to pay $2.7 million in restitution. Placeres pleaded guilty in March 2012 to one count of conspiracy to commit health care fraud and one count of conspiracy to pay and receive illegal kickbacks.

According to court documents, for more than one year, Placeres transported patients to American Therapeutic Corporation (ATC), a corporation that purported to operate partial hospitalization programs (PHPs) in seven different locations throughout south Florida and Orlando. A PHP is a form of intensive treatment for severe mental illness. The patients Placeres transported did not qualify for the services purportedly rendered by ATC. ATC then billed Medicare for false, fake, and fictitious services for the patients transported by Placeres and others.

According to court documents, Placeres also facilitated on behalf of ATC the payment of hundreds of thousands of dollars in illegal kickbacks to owners and operators of assisted living facilities and halfway houses in order to obtain patients for ATC.

According to court filings, ATC’s owners and operators paid kickbacks to owners and operators of assisted living facilities and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC. Throughout the course of the fraud conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries who did not qualify for PHP services. The ineligible beneficiaries attended treatment programs that were not legitimate so that ATC could bill Medicare for nearly $200 million in medically unnecessary services.

According to the plea agreement, Placeres’s participation in the fraud resulted in approximately $6.5 million in fraudulent billing to the Medicare program.

ATC, its management company, Medlink Professional Management Group Inc., and various owners, managers, doctors, therapists, patient brokers, and marketers of ATC were charged with various health care fraud, kickback, money laundering, and other offenses in two indictments unsealed on February 15, 2011. ATC, Medlink, and more than 20 of the individual defendants charged in these cases have pleaded guilty or have been convicted at trial.

Today’s sentence was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; John V. Gillies, Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher Dennis of the HHS Office of Inspector General (HHS-OIG), Office of Investigations, Miami Office.

The criminal case is being prosecuted by Trial Attorneys Jennifer L. Saulino, Robert A. Zink and James V. Hayes of the Fraud Section in the Justice Department’s Criminal Division. A related civil action is being handled by Vanessa I. Reed and Carolyn B. Tapie of the Civil Division and Assistant U.S. Attorney Ted L. Radway of the Southern District of Florida. The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.

Since its inception in March 2007, the Medicare Fraud Strike Force operations in nine locations have charged more than 1,330 defendants who collectively have billed the Medicare program for more than $4 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

http://www.fbi.gov/miami/press-releases/2012/miami-area-resident-sentenced-to-46-months-in-prison-for-participating-in-medicare-fraud-scheme

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