Conviction of Former American Therapeutic Employees Marks End to Massive $200 Million Fraud Scheme By Tod Aronovitz | 08/12/14 | 0 Comment

A long-running investigation into one of the nation’s largest mental health care scams against Medicare culminated in the convictions of a physician’s assistant and certified nursing assistant. The two, both residents of South Florida, were former employees of American Therapeutic Corporation (ATC), a mental health company headquartered in Miami that was connected to a massive scheme involving $200 million in fraudulent billings to Medicare.

According to a Justice Department announcement, a federal jury in Miami found Roger Bergman, 65, a physician assistant licensed in Florida, guilty of conspiracy to commit health care fraud and wire fraud and conspiracy to make false statements relating to health care matters. Rodolfo Santaya, 55, a certified nursing assistant also licensed in Florida was found guilty of conspiracy to commit health care fraud and wire fraud, conspiracy to pay and receive bribes and kickbacks, and two counts of receiving bribes and kickbacks in connection with a federal health care benefit program. Both were initially charged in a January 28 indictment.

Lawyers for the Justice Department said that Bergman and Santaya sustained a chain of fraudulent activity at an ATC clinic located in Homestead. Patients at the clinic, who were suffering from dementia, Alzheimer’s and other ailments, were exploited solely for ripping off the Medicare program. According to prosecutors, hundreds of patients were in such bad condition that they could not have benefited from any group psychotherapy sessions at American Therapeutic.

According to a July 28 story in the Miami Herald, Bergman made hundreds of fake evaluations and then falsified patients’ records showing that costly medical services were needed. The physician’s assistant processed the patients for Dr. Alberto Ayala, a psychiatrist who was earlier convicted in the scheme. Records showed Ayala was at the Homestead clinic seeing patients, when in fact, he was out of the country. Bergman, who was paid an annual salary of $90,000, left ATC in 2008, the article said.

The story also reported that Santaya acted as a patient recruiter and brought a regular influx of patients to the Homestead clinic, which helped generate $2.9 million in fraudulent Medicare billings. The certified nursing assistant, who received kickbacks from ATC’s marketing director, sometimes used that money from 2006 through 2009 to pay patients who held Medicare cards. Although Santaya was found guilty of accepting a pair of kickbacks worth 9,495 and $8,250, prosecutors believe those amounts were only part of a larger picture. Agents with the FBI and Health and Human Services found that he deposited about $50,000 in his bank account in 2009 alone.

ATC and Professional Management Group Inc.—a management company associated with ATC—as well as about 40 individuals, including ATC’s owners, have all previously pleaded guilty or have been convicted at trial in connection with the fraud scheme, including some that we have previously reported on our ARONOVITZ LAW Blog. ATC operated purported partial hospitalization programs (PHPs), a form of intensive treatment for severe mental illness, in seven locations throughout Orlando and south Florida.

The Justice Department’s investigation into ATC came to a head when federal agents raided all seven clinics in the fall of 2010. This led to the guilty plea of Lawrence Duran, the former co-owner of ATC. He was sentenced to 50 years in prison, the longest ever for a Medicare fraud offender. The other co-owner, Duran’s girlfriend, Marinella Valera, was sentenced to 35 years. Before their convictions, they pocketed around $87 million in Medicare proceeds, the Herald story said.

As far as Bergman and Santaya, they were ordered by U.S. District Judge Jose Martinez to be placed in custody at the Miami Federal Detention Center while they wait for their sentences.

How to Report Miami Medicare Fraud

Healthcare professionals or medical billing employees who have 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 up 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 whistleblowers to document Medicare fraud and other forms of fraud against the government. Contact Miami Whistleblower / Qui Tam lawyer Tod Aronovitz to discuss your case.