Former ATC Nursing Assistant Sentenced in $200 Million Medicare Fraud Scheme By Tod Aronovitz | 12/29/14 | 0 Comment

Rodolfo Santaya, a certified nursing assistant from Miami, was sentenced to serve 150 months in prison as a result of his participation in a $200 million Medicare fraud scheme at American Therapeutic Corporation (ATC).

In addition to his prison sentence, U.S. District Judge Jose E. Martinez of the Southern District of Florida ordered the 55-year old to pay more than $18.2 million in restitution, an announcement by the U.S. Department of Justice said.

As we reported earlier on our ARONOVITZ LAW Blog, Santaya and ATC physician assistant Roger Berman were convicted in July in what came to be known as the nation’s largest mental health care scam against Medicare.  Both helped carry out a chain of fraudulent activity resulting in false billings at a clinic in Homestead.

After a six-day trial, a jury found Santaya guilty of conspiracy to commit health care fraud and wire fraud, conspiracy to pay and receive bribes and kickbacks, and two counts of receipt of bribes and kickbacks in connection with a federal health care benefit program.

According to evidence presented at the trial, Santaya was paid thousands of dollars in cash kickbacks each month  to refer Medicare beneficiaries to ATC, which was headquartered in Miami but purportedly operated partial hospitalization programs (PHPs) in seven locations throughout South Florida and Orlando.

Santaya’s recruited Medicare patients—who suffered from Alzheimer’s and dementia—did not need, qualify for, or even receive PHP treatment.  However, the Homestead clinic still submitted false and fraudulent bills to Medicare for services supposedly provided to each of Santaya’s patients.

Medical professionals, including doctors who were co-conspirators in the scheme, fabricated and signed fraudulent medical documentation and patient files to support Santaya’s patient claims. Prosecutors argued that the Homestead clinic overbilled Medicare while failing to provide basic care to its elderly patients.

ATC and more than 20 individuals, including ATC co-owner Lawrence Duran, have all previously pleaded guilty or been convicted at trial. Santaya, who was initially charged in a January 28 indictment, has been in federal custody since his conviction this summer.

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.