Miami Physician Assistant Gets 15 Years for Role in $200 Million Medicare Fraud Scheme By Tod Aronovitz | 11/10/14 | 0 Comment

The nation’s biggest mental health therapy scam recently came to a head as a Miami-area physician assistant was among the last to be convicted for participating in a high-profile $200 million Medicare fraud scheme involving American Therapeutic Corporation (ATC).

The U.S. Attorney’s Office for the Southern District of Florida announced that Robert Bergman was sentenced to serve 15 years in prison and ordered to pay more than $85.3 million in restitution, both jointly and severally with his co-conspirators. The 65-year old Miami resident was found guilty in July of one count of conspiracy to commit health care fraud and wire fraud, and one count of conspiracy to make false statements relating to health care matters, as we previously reported on our ARONOVITZ LAW Blog on August 12.

According to court documents, Bergman and his co-conspirators submitted false and fraudulent claims to Medicare through ATC, which operated purported partial hospitalization programs (PHPs) in seven locations throughout South Florida and Orlando. Over the past decade, Bergman worked in two ATC clinics in Miami and Homestead.

Evidence at trial showed that Bergman and other medical professionals at ATC fabricated and signed fraudulent medical documentation and patient files in order to support ATC’s fraudulent billings to Medicare. False submissions included claims for ineligible PHP patients such as those who were in neuro-vegetative states, late stages of diseases causing permanent cognitive memory loss, or living in halfway houses for substance abuse issues. It was found that facility owners forced many of these patients to attend ATC, but they did not receive treatment for their actual medical conditions.

According to a recent story in the Miami Herald, ATC was raided in 2010 leading to the conviction of co-owner and chief executive, Lawrence Duran. Duran was sentenced to 50 years in prison—the longest ever for a Medicare fraud offender—while his co-owner and therapist girlfriend Marianella Valera received a 35-year sentence.

The article reported that Bergman’s defense lawyer argued for a lesser sentence, saying that Bergman was a ‘bit’ player in the grand scheme, but to no avail. Even though Bergman left ATC two years before it was shut down, Justice Department prosecutor Nicholas Surmacz demonstrated at Bergman’s trial in July that he processed patients for ATC psychiatrist Alberto Ayala, who was often out of the country despite records purportedly showing he was at the Miami and Homestead clinics seeing patients.

At the sentencing hearing, Surmacz said, “They trafficked human beings … and used those people to try to steal $200 million from Medicare. He (Bergman) literally put tens of millions of dollars into the owners’ pockets.”

(Note: Some newspaper reports give the defendant’s name as Roger Bergman. Robert Bergman is the name given in the news release by the FBI’s Miami Division.)

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.