Two Get 85 Years in Prison for Mental Health Care Fraud 
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 Two Get 85 Years in Prison for Mental Health Care Fraud

Two Get 85 Years in Prison for Mental Health Care Fraud
By JOHN M. GROHOL, PSYD
Founder & Editor-in-Chief

Miami and Medicare fraud. The two go hand-in-hand like a baby in a
basket.

So it probably wasnt the brightest idea for Lawrence Duran and
Marianella Valera to set up a company called American Therapeutic to
run a chain of seven mental health clinics in South Florida and
Orlando that duped Medicare into paying out $87 million during the
past decade.

It probably didnt help that, in order to perpetuate their fraud
against U.S. taxpayers, they held charting parties gatherings
where they would falsify the medical records of beneficiaries to make
it look like they needed therapy when they actually didnt, according
to the Miami Herald.

In the past week, both have been given huge prison sentences 50
years for Lawrence Duran and 35 years for mental health counselor
Marianelle Valera, who will be looking to be released from prison when
shes 75 years old.

Crime doesnt pay, not even in mental health.

The couple and their employees actually submitted $205 million in
fraudulent billings to Medicare, but Medicare only paid out $87.5
million. The couple and their co-defendants were ordered to pay $87.5
million restitution while in prison (its not clear to me how they can
do this, but whatever).

American Therapeutic was one of the nations largest chains of
community mental health centers licensed by Medicare. It seems a lot
of people were in on the scheme:

In the past year, Duran and Valera were charged along with 32 other
American Therapeutic employees, psychiatrists, counselors, nurses,
marketers, patient recruiters and others who supplied Medicare
beneficiaries in exchange for kickbacks. American Therapeutic billed
Medicare for thousands of patients, including many with dementia and
Alzheimers disease, who had no way of benefiting from the companys
costly group-therapy sessions, prosecutors said. [...]

About a dozen of the defendants have been convicted, including Duran
and Valeras top aides, Margarita Acevedo, who ran the marketing
operation to bring in patients, and Judith Negron, who was in charge
of a subsidiary, MedLink, which laundered Medicare profits to pay
employees and kickbacks. Another employee, Joseph Valdes, who worked
under Acevedo, also pleaded guilty.

According to the U.S. Department of Justice, as part of the fraud
scheme, Duran, Valera and others paid kickbacks to owners and
operators of assisted living facilities and halfway houses and to
patient brokers in exchange for delivering ineligible patients to
American Therapeutic. In some cases, the patients received a portion
of those kickbacks. The defendants and their co-conspirators actively
recruited assisted living facilities and halfway house owners and
operators and patient brokers to participate in the scheme.

Duran was also a board member of the National Association of
Behavi{*filter*}Health (NABH), an organization begun in 2006 to lobby
Congress to keep funding going for partial hospitalization programs.
The kinds of programs that American Therapeutic relied on for a great
deal of its income.

In actuality, NABH was an organization that provided Duran a
legitimate-looking vehicle to lobby Congress to allocate more money,
through Medicare, to Duran and his co-conspirators for their
fraudulent claims, Justice Department lawyer Jennifer Saulino wrote
in a recent court filing.

He directed NABH staff to disseminate to other [community mental
health centers] the tricks of his trade, Saulino wrote, noting how he
instructed others on ways in which to win appeals of Medicare denials
of claims, based on ATCs experience. [...]

Last week, another Miami member of the lobbying organization, Biscyane
Milieu Health Center, was implicated in an indictment charging its
owners and about 20 others with Medicare fraud.

Oooopsie! Perhaps its not a good idea in hindsight to setup a
lobbying group whose sole purpose is seemingly to keep the federal
gravy train running.

According to news reports, these sentences are the harshest ever
handed down for Medicare fraud. Ever. The previous winner was a Miami
doctor who was convicted for an $11 million HIV-therapy scam and
sentenced to 30 years in prison.

Kudos to the U.S. Justice Department and Justice Department lawyer
Jennifer Saulino for the convictions and to U.S. District Judge James
Lawrence King for handing down such stiff sentences. I hope this sends
a message to others looking to defraud the government (which is
ultimately you and I, since we pay for the government) youre going
to jail for a very long time when youre caught.

Read the full articles:

Miami couple faces lengthy sentence for Medicare fraud Miami Herald

U.S. mental-health executive gets 35 years for fraud Reuters

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Dr. John Grohol is the CEO and founder of Psych Central. He has been
writing about online behavior, mental health and psychology issues,
and the intersection of technology and psychology since 1992. Dr.
Grohol also sits on the editorial board of the journal
{*filter*}psychology, Behavior and Social Networking and is a founding
board member of the Society for Participatory Medicine.

http://www.***.com/



Sun, 09 Mar 2014 09:04:18 GMT
 
 [ 1 post ] 

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