Rodolfo Santaya, Health Care Fraud and Wire Fraud, Alabama 2014

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Table of Contents

Miami Nursing Assistant Sentenced to 150 Months for $200M Medicare Fraud

A Miami licensed nursing assistant has been sentenced to serve 150 months in prison for participating in a $200 million Medicare fraud scheme involving fraudulent billings by American Therapeutic Corporation (ATC), a mental health company headquartered in Miami.

Rodolfo Santaya, 55, of Miami, was convicted on July 18, 2014, after a six-day jury trial, of conspiracy to commit health care fraud and wire fraud, conspiracy to pay and receive bribes and kickbacks, and two counts of receipt of bribes and kickbacks in connection with a federal health care benefit program.

Santaya was paid thousands of dollars a month in cash kickbacks in exchange for referring Medicare beneficiaries to ATC, which operated purported partial hospitalization programs (PHPs) in seven locations throughout South Florida and Orlando, according to evidence presented at trial.

A PHP is a form of intensive treatment for severe mental illness. However, evidence showed that the Medicare beneficiaries Santaya sent to ATC did not need, qualify for, nor receive PHP treatment.

ATC submitted false and fraudulent bills to Medicare for services purportedly provided to each of Santaya’s patients. In order to justify ATC’s fraudulent billings, medical professionals, including doctors, fabricated and signed fraudulent medical documentation and patient files.

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 U.S. Attorney’s Office for the Southern District of Florida.

Santaya has been in federal custody since his conviction. In addition to the prison sentence, U.S. District Judge Jose E. Martinez of the Southern District of Florida ordered Santaya to pay more than $18.2 million in restitution.

The Medicare Fraud Strike Force has charged nearly 2,000 defendants who have collectively billed the Medicare program for more than $6 billion since its inception in March 2007.