Inpatient Facility Coding & Compliance Alert

Medicare Fraud Strike Force adds another clinic to its list.

Biscayne Milieu (a Miami-based mental health clinic) and its owners and operators were sentenced in early April for participation in a Medicare fraud scheme involving the submission of more than $50 million in fraudulent billings to Medicare. The announcement was made by Mythili Raman of the U.S. Justice Department’s criminal division and other representatives of the U.S. Attorney’s office, FBI, and U.S. Department of Health and Human Services.

Three defendants were each convicted on Aug. 24, 2012, of conspiracy to commit health care fraud, at least one substantive count of health care fraud, and conspiracy to offer and pay kickbacks following a two-month jury trial. Antonio and Jorge Macli and Sandra Huarte were also each convicted of conspiracy to commit money laundering and substantive money laundering counts at trial. 

Evidence during the trial showed that the defendants:

·         Created and oversaw a scheme in which they, along with their co-defendants, submitted over $50 million in false and fraudulent claims to Medicare through Biscayne Milieu

·         Paid patient recruiters more than $1 million in illegal kickbacks to refer ineligible Medicare beneficiaries to Biscayne Milieu for services that were never provided or that were not reimbursable under applicable Medicare rules

·         Billed Medicare for tens of millions of dollars in PHP (Partial Hospitalization Program) treatments for these patients 

·         Directed co-conspirators to create falsified medical records intended to conceal their Medicare fraud and phony “case manger” contracts in an attempt to hide their extensive illegal kickbacks

·         Used a series of ostensibly legitimate corporations to conceal and launder Biscayne Milieu’s fraudulent profits.

Sentences for the three defendants ranged from 262 to 360 months in prison plus three years of supervised release. The corporate entity was also sentenced to one year of probation. Restitution payments for each of the defendants will be determined on April 25, 2013.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion.

To read the complete statement, visit http://www.justice.gov/opa/pr/2013/April/13-crm-387.html.