Former Biscayne Milieu Therapist Team to Pay $11 Million in Miami Health Care Fraud By Tod Aronovitz | 11/25/16 | 0 Comment

Following his conviction on August 7 of one count of conspiring to commit health care fraud, Jose Rojo of Miami was recently sentenced for his role in a $55 million dollar Medicare fraud scheme.  The former therapist at the Miami-based mental health clinic, Biscayne Milieu, was sentenced to 120 months in prison, ordered to pay more than $11 million in restitution with his co-defendants, and will be under supervised release for three years, as a result.

According to court documents, the 39-year old Rojo and his conspirators formulated a Miami health care fraud scheme to pay patient recruiters to refer ineligible Medicare beneficiaries to Biscayne Milieu, a clinic which allegedly provided a partial hospitalization program (PHP) for severe mental illness.  However, PHP services were never provided to most of the referred patients because they were chronic substance abusers, suffered from severe dementia and group therapy would not help, or had no mental health issues at all but instead were seeking exemptions for their U.S. citizenship applications.

The evidence at trial showed that the therapy sessions Rojo led were a charade.  He often showed up late or not at all, but Medicare was still billed for full sessions. Rojo also concealed the phony treatment plans and group therapy notes by generating fraudulent documentation.  Many of these documents were copied from patient to patient, years apart, but because they were so identical—down to the descriptions of patients’ statements and misspelled words—Rojo’s connection was discovered. In addition, Rojo sold fake group therapy notes to the other clinic therapists.

Biscayne Milieu billed Medicare for tens of millions of dollars in PHP treatments for these patients alone. Overall, submissions of more than $55 million dollars in fraudulent claims to Medicare were made through Biscayne Milieu.

According to a news release issued by the U.S. Department of Justice, several additional owners, doctors, managers, therapists, patient brokers and other employees of Biscayne Milieu have been charged with health care fraud, kickback violations, money laundering and other offenses in two indictments unsealed in September 2011 and May 2012. Biscayne Milieu, its owners, and more than 25 of the individual defendants have pleaded guilty or been convicted at trial, including Antonio and Jorge Macli and Sandra Huarte, the owners and operators of Biscayne Milieu.  They were sentenced in April to 30 years, 25 years, and 22 years in prison, respectively.

How to Report Miami Health Care Fraud

Healthcare or medical billing employees who have inside knowledge of questionable Medicare billing practices can file a confidential legal claim under the False Claims Act. By acting as a “whistleblower” in what is known as a “qui tam” lawsuit, a private party may collect between 10 to 30 percent of the amount recovered, depending on how the case is prosecuted.

ARONOVITZ LAW: Miami Whistleblower / Qui Tam Law Firm

The Miami Qui Tam law firm of ARONOVITZ LAW routinely works with Miami whistleblowers to document Medicare fraud and other forms of fraud against the government. Contact Miami Whistleblower / Qui Tam lawyer Tod Aronovitz to discuss a case.