Physician Assistant and Certified Nursing Assistant Convicted in $200 Million Medicare Fraud Scheme
A federal jury in Miami today convicted a physician assistant and a certified nursing assistant, both South Florida residents, for their participation in a Medicare fraud scheme involving approximately $200 million in fraudulent billings by American Therapeutic Corporation (ATC), a mental health care company headquartered in Miami.
Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office, and Acting Special Agent in Charge Reginald France of the Health and Human Services Office of Inspector General (HHS-OIG) region including all of Florida made the announcement.
Roger Bergman, 65, a physician assistant licensed in Florida, and Rodolfo Santaya, 55, a certified nursing assistant licensed in Florida, were each charged in an indictment on Jan. 28, 2014. Today, Bergman was found guilty of conspiracy to commit health care fraud and wire fraud and conspiracy to make false statements relating to health care matters. Santaya was found guilty of conspiracy to commit health care fraud and wire fraud, conspiracy to pay and receive bribes and kickbacks, and two counts of receiving bribes and kickbacks in connection with a federal health care benefit program.
ATC, Medlink Professional Management Group Inc. – a management company associated with ATC – and multiple individuals, including ATC’s owners, have all previously pleaded guilty or have been convicted at trial in connection with the fraud scheme. ATC operated purported partial hospitalization programs (PHPs) in seven locations throughout Orlando and south Florida. A PHP is a form of intensive treatment for severe mental illness.
According to evidence presented at trial, Bergman, Santaya and their co-conspirators caused the submission of fraudulent claims to Medicare through ATC seeking reimbursement for mental health services that were not provided or were provided to patients who were not eligible to receive the services. Bergman, who worked at ATC’s Miami and Homestead, Florida, offices, created, falsified and signed fraudulent medical documentation to make it appear to Medicare that ATC’s patients qualified for, and received, PHP services, even though they did not. Santaya received hundreds of thousands of dollars in illegal kickback payments in exchange for delivering ineligible Medicare beneficiaries to ATC’s Homestead office.
Throughout the course of the conspiracy, ATC and its employees paid tens of millions of dollars in kickbacks in exchange for the names and identification numbers of Medicare beneficiaries so that ATC could fraudulently bill Medicare for PHP services that it never provided or that it purportedly provided to beneficiaries who were not eligible to receive PHP treatment.
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. The case is being prosecuted by Assistant Chief Robert A. Zink and Trial Attorneys Nicholas E. Surmacz and Kelly Graves of the Criminal Division.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 1,900 defendants who have collectively billed the Medicare program for more than $6 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 Team (HEAT), go to: www.stopmedicarefraud.gov.