WASHINGTON – Eight individuals and a
Miami-based corporation were convicted by a federal jury for their
participation in a Medicare fraud scheme involving the submission of more than
$50 million in fraudulent billings to Medicare, the Department of Justice, the
FBI and the Department of Health and Human Services (HHS) announced today.
Antonio Macli, the owner of Biscayne Milieu
Health Center Inc., a mental health care corporation, his son Jorge Macli,
Biscayne Milieu’s CEO, and Antonio Macli’s daughter Sandra Huarte, an executive
at the company, were each found guilty in U.S. District Court for the Southern
District of Florida of one count of conspiracy to commit health care fraud, and
one or more substantive counts of health care fraud, conspiracy to commit a
health care kickback scheme and conspiracy to commit money laundering and
substantive counts of money laundering.
Antonio Macli and Jorge Macli were also convicted of substantive
kickback counts. Dr. Gary Kushner, the
medical director at Biscayne Milieu, was found guilty of conspiracy to commit
health care fraud and a substantive count of health care fraud. Rafael Alalu, a therapist, and Jacqueline
Moran, who handled Medicare billing for Biscayne Milieu, were each found guilty
of conspiracy to commit health care fraud and substantive counts of health care fraud. Anthony Roberts and Derek Alexander, two
patient recruiters, were each found guilty of one count of conspiracy to commit
a health care kickback scheme, and each was convicted of one health care
kickback count.
The defendants were charged in a superseding
indictment returned June 5, 2012. Twenty
other individuals who worked at Biscayne Milieu have all previously pleaded
guilty.
Evidence at trial demonstrated that the
defendants and their co-conspirators caused the submission of false and
fraudulent claims to Medicare through Biscayne Milieu, a Florida corporation
headquartered in Miami that purported to operate a partial hospitalization
program (PHP) in that city. Biscayne
Milieu purported to provide PHP services, a form of intensive treatment for
severe mental illness, for Medicare beneficiaries suffering from mental
illnesses. In fact, however, the defendants devised a scheme in which they paid
patient recruiters to refer ineligible Medicare beneficiaries to Biscayne
Milieu for PHP services, which were never provided. Many of the beneficiaries admitted to
Biscayne Milieu were not eligible for PHP because they were chronic substance
abusers, suffered from severe dementia or Alzheimer’s disease and would not
benefit from group therapy, or had no mental health diagnosis at all. Indeed, some beneficiaries were seeking
fraudulent mental health treatment in order to be declared exempt from certain
requirements for their applications for U.S. citizenship.
As part of a scheme orchestrated by Antonio
Macli, Jorge Macli and Huarte, Biscayne Milieu used fraudulent documents
created by Alalu and others and bogus certifications signed by psychiatrists,
including Kushner, to bill Medicare for tens of millions of dollars in false
and fictitious services. Kushner did not
treat patients but rather created and certified false documents to make it
appear that ineligible patients were receiving legitimate PHP treatment. In addition, the evidence at trial showed
that Alexander and Roberts solicited and received illegal kickbacks in exchange
for sending ineligible patients to Biscayne Milieu.
Throughout the course of the fraud conspiracy,
beneficiaries who did not qualify for PHP services attended treatment programs
that did not provide legitimate PHP services.
Biscayne Milieu billed tens of millions of dollars in services to
patients who did not need the services and to whom the appropriate services
were not provided. According to the
evidence, co-conspirators personally altered, and caused the alteration of,
patient files and therapist notes for the purpose of making it appear, falsely,
that patients being treated by Biscayne Milieu were qualified for PHP
treatments and that the treatments provided were legitimate PHP
treatments. Evidence further revealed
that Kushner signed patient files without providing meaningful treatment, and
Biscayne Milieu then billed Medicare for millions of dollars in PHP treatment
for these patients under his name as the attending physician. Once Biscayne Milieu received reimbursement
from Medicare for these fraudulent services, its owners and executives
laundered the money through various accounts to launder the proceeds of their
illegal scheme.
Kushner and Alalu were remanded into
custody. Antonio Macli, Jorge Macli,
Huarte, Alexander and Roberts were already in custody.
Today’s verdicts were announced 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; Michael B.
Steinbach, Acting Special Agent-in-Charge of the FBI Miami field office; and
Special Agent-in-Charge Christopher Dennis of the HHS Office of Inspector
General (HHS-OIG), Office of Investigations Miami office.
The criminal case is being prosecuted by
Assistant U.S. Attorneys Michael Davis, Marlene Rodriguez, and Alicia Shick of
the Southern District of Florida, and Trial Attorney James V. Hayes of the
Justice Department Criminal Division’s Fraud Section. The investigation was led by the FBI with
assistance from HHS-OIG, and was brought by the Medicare Fraud Strike Force, a
joint effort of the U.S. Attorney’s Office for the Southern District of Florida
and the Criminal Division’s Fraud Section.
Since its inception in March 2007, the
Medicare Fraud Strike Force, now operating in nine cities across the country,
has charged more than 1,330 defendants who have collectively billed the
Medicare program for more than $4 billion.
In addition, HHS’s Centers for Medicare and Medicaid Services, working
in conjunction with HHS-OIG, is 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.
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