Topic: Whistleblower Litigation
Seven Miami residents were arrested for their alleged roles in a scheme that fraudulently billed Medicare and Florida Medicaid for $63 million, the U.S. Department of Justice said.
Roger Rousseau, the 71-year-old former medical director of the now defunct health care provider Health Care Solutions Network, was indicted on July 11 and charged with conspiring to commit health care fraud and two counts of health care fraud, the department said in an email statement.
In the indictment, six therapists – Doris Crabtree, 61, Angela Salafia, 65, Liliana Marks, 46, Ruben Busquets, 49, Alina Fonts, 47, and Blanca Ruis, 59 – were also charged with conspiracy to commit heath care fraud, the Department of Justice said.
Fonts was charged with two counts of health care fraud, and Crabtree, Salafia, Marks and Busquets were each charged with two counts of making false statements related to heath care matters.
It wasn’t immediately known if they had attorneys. The indictment also seeks forfeiture proceeds from the alleged offenses, the department said.
In February, Health Care Solutions Network’s owner, Armando “Manny” Gonzalez, was sentenced to 14 years in prison for Medicare fraud charges. Gonzalez was arrested last year with dozens of others involved in his company, the Miami Herald reported. Almost all of them have pleaded guilty.
The indictment states that from 2004 to 2011 Health Care Solutions Network claimed to provide mental health treatment to Medicare and Medicaid beneficiaries for mental health services that were not necessary and often not provided, the department said.
Also, assisted living facility owners and operators who referred people to the network were allegedly paid kickbacks, according to the indictment.
In total, the heath care provider fraudulently billed about $63.7 million and allegedly received payments totaling about $28 million, the department said.
In this case, the indictment alleges that Rousseau signed what he knew was fabricated and changed medical records without reviewing the materials and sometimes without meeting the patient. The indictment also alleges that Crabtree, Salafia, Marks, Busquets, Fonts and Ruiz fabricated medical records to support false claims for partial hospitalization program services that were never provided and weren’t medically necessary, the department said.
This case is being investigated by the FBI and the U.S. Department of Health and Human Services Office of Inspector General, and it is part of the Medicare Fraud Strike Force. Since starting in 2007, the strike force has charged about 1,500 defendants who have collectively billed the Medicare program for about $5 billion.
Article by Samantha Shavell, visit: www.NBCMiami.com
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