Jose Rojo, Medicare Fraud, Florida 2013

A former therapist for Biscayne Milieu, a Miami-based mental-health clinic, was sentenced to 10 years in prison for his participation in a $55 million Medicare fraud scheme.

Jose Rojo, 39, of Miami, was sentenced by U.S. District Judge Marcia G. Cooke in the Southern District of Florida on [missing sentencing date]. Rojo was convicted on August 7, 2013, of one count of conspiring to commit health care fraud following a one-month jury trial.

In addition to the prison term, Rojo was ordered to pay more than $11 million in restitution, jointly and severally with his co-defendants, and to serve three years of supervised release.

The evidence at trial showed that Rojo and his co-conspirators caused the submission of more than $55 million dollars in fraudulent claims to Medicare through Biscayne Milieu, which purportedly operated a partial hospitalization program (PHP) – a form of intensive treatment for severe mental illness.

Many of the patients admitted to Biscayne Milieu were not eligible for PHP because they were chronic substance abusers, suffered from severe dementia and would not benefit from group therapy, or had no mental health diagnosis but were seeking exemptions for their U.S. citizenship applications.

The evidence at trial further showed that Rojo conducted sham therapy sessions for patients he knew were ineligible for PHP treatment. Often Rojo showed up late for these sessions or not at all, but Medicare was still billed as if a full session took place.

Biscayne Milieu billed Medicare for tens of millions of dollars in PHP treatments for these patients. Various owners, doctors, managers, therapists, patient brokers and other employees of Biscayne Milieu have also been charged with health care fraud, kickback violations, money laundering and other offenses in two indictments unsealed in September 2011 and May 2012.

This case was investigated by the FBI with the assistance of HHS-OIG and was brought by 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. The case is being prosecuted by Assistant U.S. Attorneys Marlene Rodriguez and James V. Hayes of the Southern District of Florida.

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