Owner of Miami-Area Assisted Living Facility Sentenced to 37 Months in Prison for Role in Medicare Fraud Scheme

WASHINGTON—The owner of a Miami-area assisted living facility was sentenced today to 37 months in prison for her role in a kickback scheme that funneled patients to a fraudulent mental health provider, American Therapeutic Corporation (ATC), the Department of Justice, the FBI, and the Department of Health and Human Services announced today.

Billy Denica, 50, was sentenced by U.S. District Judge Joan A. Lenard in Miami. In addition to her prison term, Denica was sentenced to two years of supervised release and was ordered to pay $538,875 in restitution. Denica pleaded guilty on April 2, 2012 to one count of conspiracy to commit health care fraud.

Denica was the owner of an assisted living facility called Robyll Care Assisted Living Facility. According to court documents, Denica agreed to send Robyll residents to ATC in exchange for illegal health care kickbacks. ATC purported to operate partial hospitalization programs, a form of intensive treatment for severe mental illness, in seven different locations throughout south Florida and Orlando. According to court documents, Denica admitted that she knew ATC falsely billed Medicare for PHP treatment based on her fraudulent referrals. Denica was aware that some of the Robyll residents would be offered gifts such as money, cigarettes, and candy so that they would agree to be admitted to a hospital for purposes of later attending ATC. She also admitted that she referred her residents to ATC because they had Medicare, because she would receive a cash kickback, and because they were willing to go. According to the plea agreement, Denica’s participation in the fraud resulted in more than $1.1 million in fraudulent billing to the Medicare program.

ATC, its management company Medlink Professional Management Group Inc., and more than 20 individual defendants charged for their participation in the scheme have pleaded guilty or have been convicted at trial.

The sentencing was announced today by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Xanthi C. Mangum, Acting Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the HHS Office of Inspector General (HHS-OIG), Office of Investigations Miami Office.

The case was prosecuted by Trial Attorneys Allan J. Medina, Steven Kim, and William Parente of the Criminal Division’s Fraud Section. The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.

Since their inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.