Feds spotlight South Florida’s mental health clinics for “questionable billing” to Medicare

 

A new federal report shines light on South Florida’s mental health clinics for submitting “questionable billing” to Medicare, as prosecutors crack down on multimillion-dollar fraud schemes.

jweaver@MiamiHerald.com

No area of the country cheats Medicare quite like South Florida.

Consider this nugget in a new federal report: A Broward County mental health clinic billed the taxpayer-funded program for a patient who lived in Hawaii — 4,000 miles away. The same clinic’s 77 other Medicare patients resided an average of 550 miles away, according to the report by the inspector general for the Department of Health and Human Services.

The vast majority of the nation’s mental health clinics with “questionable billing” were concentrated in South Florida and other metropolitan areas of Texas and Louisiana, collecting tens of millions of dollars in Medicare payments for purported therapy services in 2010, the report says.

By the end of that year, Justice Department prosecutors had launched a major offensive against the nation’s biggest mental-health chain, Miami-based American Therapeutic Corp., leading to convictions of the company, its top executives and more than 30 other defendants in a $205 million Medicare scam.

And last Friday, a Miami federal jury found another local mental-health clinic, Biscayne Milieu Health Center, along with its owner, his son and daughter, and five others, guilty of conspiring to bilk $57 million from the federal program for the elderly and disabled. Twenty other defendants who had worked at the Miami Gardens clinic pleaded guilty before trial.

“No matter where in the chain of the fraud — whether you’re a doctor, a clinic owner, a therapist, a billing clerk or a patient recruiter — you will be held accountable for your actions,” U.S. Attorney Wifredo Ferrer said after the verdict.

After the nearly two-month trial, the jury convicted Biscayne Milieu’s owner, Antonio Macli; the company’s operating officer, son Jorge Macli; and another manager, daughter Sandra Huarte, of conspiracy to commit healthcare fraud by collecting $11 million in Medicare payments for therapy services that were not provided or needed from 2007-11.

The father, son and daughter were also found guilty of conspiring to pay kickbacks to patient recruiters who supplied Medicare beneficiaries living primarily at halfway houses in South Florida. They included many with substance-abuse problems who did not meet the Medicare eligibility requirements, prosecutors said.

Some of those with drug or alcohol addictions were lured from out of state with promises to put a roof over their heads. Once they arrived, with their valuable Medicare cards in hand, they would be squeezed into Broward and Miami-Dade halfway houses and steered to Biscayne Milieu’s purported mental-health programs, according to prosecutors. But if they dropped out of the group therapy sessions, they would lose their housing.

A social worker at Biscayne Milieu also assisted patients seeking U.S. citizenship by completing immigration forms falsely indicating they suffered from mental illnesses. That enabled the patients to avoid taking the citizenship test, prosecutors said.

Also convicted of healthcare fraud at trial: Biscayne Milieu’s medical director, Dr. Gary Kushner, a Fort Lauderdale psychiatrist; Rafael Alalu, a clinic therapist; and Jacqueline Moran, who handled the company’s Medicare billing.

According to trial evidence, the clinic’s executives, along with Kushner and Alalu, fabricated records, prescriptions and certifications to make it appear that ineligible patients received legitimate mental health treatment.

Two patient recruiters, Anthony Roberts and Derek Alexander, were also found guilty of participating in the scheme by seeking and accepting kickbacks in exchange for sending patients to the Biscayne Milieu clinic in an office park off the Palmetto Expressway.

All eight defendants, except Moran, are being held at the Federal Detention Center as they await sentencing in December.

Their convictions followed another long trial that ended in June. Two South Florida doctors, psychiatrists Mark Willner of Weston and Alberto Ayala of Coral Gables, the medical directors for American Therapeutic Corp., were found guilty for their roles in a conspiracy to fleece $205 million from Medicare.

In addition, the jury convicted Vanja Abreu, program director for American Therapeutic in Miami-Dade, of the same healthcare-fraud conspiracy offense, and two other defendants, Hilario Morris and Curtis Gates, of paying kickbacks to group home operators in exchange for providing patients.

Since American Therapeutic’s six South Florida clinics shuttered nearly two years ago, more than 30 defendants have been charged in the case with the majority pleading guilty.

In his latest report, Health and Human Services’ Inspector General Daniel Levinson cited the case of American Therapeutic, which was paid $83 million by Medicare from 2003-10, as an example of the federal program’s “vulnerabilities.” The chain’s owner, Lawrence Duran, is serving a 50-year prison term, the longest sentence for a Medicare fraud offender.

Overall, the report criticized Medicare for its lack of oversight of about 200 so-called community mental health centers in 25 states, which received a total of $218.6 million in 2010. Most of those clinics, which were not identified, were located in Florida, Texas and Louisiana.

Half of all the mental health centers “met or exceeded the threshold that indicated unusually high billing,” the report says.

About two-thirds of those “questionable” therapy centers were located in eight metropolitan areas, including Miami, Tampa and Jacksonville. The Miami area, with 32 questionable clinics among a total of 52 in South Florida, scored the worst nationally, according to the inspector general’s report.

In response, Medicare officials acknowledged that mental health services “have historically been vulnerable to fraud, waste and abuse.”

But Medicare Acting Administrator Marilyn Tavenner wrote in a July memo to the inspector general that the program “is taking additional steps to address potential vulnerabilities.”

She said Medicare has adopted computer software to screen prospective clinic operators, including doing criminal background checks, and to scrutinize claims, which are regularly paid within 14 days.

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