Eight Individuals and a Corporation Convicted at Trial in Florida in $50 Million Medicare Fraud Scheme

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.