Roger Bergman, Medicare Fraud, Florida 2014

A Miami-area physician assistant was sentenced to serve 15 years in prison for his role in a massive Medicare fraud scheme that bilked the program out of approximately $200 million.

Roger Bergman, 65, of Miami, was sentenced by U.S. District Judge Jose E. Martinez in the Southern District of Florida.

The scheme, which was orchestrated by American Therapeutic Corporation (ATC), a mental health company headquartered in Miami, involved the submission of false and fraudulent claims to Medicare through ATC's purported partial hospitalization programs (PHPs) in seven different locations throughout South Florida and Orlando.

A PHP is a form of intensive treatment for severe mental illness, but in this case, the programs were used as a means to bilk the Medicare program out of millions of dollars. Evidence at trial demonstrated that Bergman and his co-conspirators fabricated and signed fraudulent medical documentation and patient files in order to justify ATC's fraudulent billings to Medicare.

The scheme was elaborate, with many patients being forced by assisted living facility owners and halfway house owners to attend ATC, and they did not receive treatment for their actual medical conditions. The patients were ineligible for PHP treatment due to various reasons such as being in neuro-vegetative states, in the late stages of diseases causing permanent cognitive memory loss, or having substance abuse issues and living in halfway houses.

Bergman was convicted of one count of conspiracy to commit health care fraud and wire fraud, and one count of conspiracy to make false statements relating to health care matters. He has been in federal custody since his conviction in 2014.

In addition to the prison sentence, Bergman was ordered to pay more than $85.3 million in restitution, both jointly and severally with his co-conspirators.

The case is being investigated by the FBI and HHS-OIG 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.

Source: https://www.justice.gov/archives/opa/pr/miami-area-physician-assistant-sentenced-15-years-prison-200-million-medicare-fraud-scheme