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$200 Million Medicare Fraud Scheme Uncovered
A shocking $200 million Medicare fraud scheme has been uncovered in South Florida, with a physician assistant and a certified nursing assistant convicted of their involvement in the massive scam.
Roger Bergman, a 65-year-old physician assistant licensed in Florida, and Rodolfo Santaya, a 55-year-old certified nursing assistant licensed in Florida, were each charged in an indictment on January 28, 2014. Bergman was found guilty of conspiracy to commit health care fraud and wire fraud, and conspiracy to make false statements relating to health care matters. Santaya 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.
The scheme involved American Therapeutic Corporation (ATC), a mental health care company headquartered in Miami. ATC operated purported partial hospitalization programs (PHPs) in seven locations throughout Orlando and south Florida. Bergman, who worked at ATC’s Miami and Homestead, Florida, offices, created, falsified and signed fraudulent medical documentation to make it appear to Medicare that ATC’s patients qualified for, and received, PHP services, even though they did not. Santaya received hundreds of thousands of dollars in illegal kickback payments in exchange for delivering ineligible Medicare beneficiaries to ATC’s Homestead office.
Throughout the course of the conspiracy, ATC and its employees paid tens of millions of dollars in kickbacks in exchange for the names and identification numbers of Medicare beneficiaries so that ATC could fraudulently bill Medicare for PHP services that it never provided or that it purportedly provided to beneficiaries who were not eligible to receive PHP treatment.
The case is being investigated by the FBI and the Health and Human Services Office of Inspector General, and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.
Assistant Attorney General Leslie R. Caldwell of the Criminal Division’s Fraud Section, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office, and Acting Special Agent in Charge Reginald France of the HHS-OIG region including all of Florida made the announcement.
The Medicare Fraud Strike Force has charged nearly 1,900 defendants who have collectively billed the Medicare program for more than $6 billion since its inception in March 2007.
For more information on the Health Care Fraud Prevention and Enforcement Team (HEAT), please visit: www.stopmedicarefraud.gov.
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Key Facts
- State: Florida
- Category: Fraud & Financial Crimes|White Collar Crime
- Source: DOJ Press Release ↗
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