WASHINGTION – Four individuals and two Miami health care companies were hit with a barrage of charges today in connection with a massive Medicare healthcare fraud scheme that bilks the federal program out of nearly $200 million.
The indictment alleges that Lawrence S. Duran, Marianella Valera, Judith Negron, and Margarita Acevedo, aka Margarita De La Cruz, conspired with their respective companies – American Therapeutic Corporation (ATC) and Medlink Professional Management Group Inc. (Medlink) – to submit false claims for mental health services that were medically unnecessary or not provided at all.
According to the indictment, the defendants operated a scheme to defraud the Medicare program by paying kickbacks to owners and operators of assisted living facilities and halfway houses in exchange for delivering patients to ATC facilities. In many instances, the patients received a portion of the kickbacks, and ATC billed Medicare for services that were not medically necessary or were not provided at all.
“Since the Strike Force began operation, we have rarely seen anything like the illegal conduct charged in this indictment, both in terms of the nature and size of the scheme,” said Assistant Attorney General Lanny A. Breuer of the Criminal Division. “The Strike Force is committed to finding and prosecuting individuals and companies who aim to cheat the American taxpayer in this way.”
A temporary restraining order has been obtained to freeze the assets of the indicted companies and individuals. The indictment charges ATC and Medlink with one count of conspiracy to commit healthcare fraud, as well as 11 counts of healthcare fraud. The individuals are charged with one count of conspiracy to defraud the United States, to receive healthcare kickbacks and to pay healthcare kickbacks.
The alleged fraud in this case was undermining a Medicare healthcare program that provides an important benefit for beneficiaries who need outpatient psychiatric services. Today’s coordinated criminal and civil action has moved in a targeted manner to assure that vital resources meant for beneficiaries are protected, that fraud and abuse in this program are eliminated, and at the same time, that defendants are stripped of their ill-gotten gains.
A 13-count indictment unsealed today in U.S. District Court in the Southern District of Florida charges ATC and Medlink, as well as Duran, Valera, Negron, and Acevedo with various counts of healthcare fraud and conspiracy. The individuals were all arrested this morning in Miami and are set to make initial appearances in U.S. District Court later today. Federal agents are conducting search warrants today at six ATC and Medlink locations.
The alleged scheme was uncovered through a coordinated effort between the Department of Health and Human Services and the Criminal Division’s Health Care Fraud Prevention and Enforcement Action Team (HEAT) Strike Force. The investigation was led by Assistant Attorney General Lanny A. Breuer and Assistant Attorney General Tony West.
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