Patient Recruiter Pleads Guilty in $190 Million Medicare Fraud Case
NEW YORK ( MainStreet) The Medicare Fraud Strike Force (MFSF) nabs another one. A patient recruiter for American Therapeutic Corporation (ATC), a fraudulent Miami-area mental health company, pleaded guilty January 17 for her role in a $190 million Medicare fraud scheme. Mayelin Santoyo, 28, of Miami pleaded guilty in federal court for the Southern District of Florida to one count of conspiracy to receive health care kickbacks. She will be sentenced March 28.
According to the Department of Justice communique, Santoyo was a patient recruiter for the now-defunct ATC. The company supposedly operated partial hospitalization programs (PHPs), a mental illness treatment plan.
Santoyo recruited Medicare beneficiaries in exchange for kickbacks. The amount she received was contingent upon the number of days each recruited patient spent at ATC. These patients were not qualified to receive PHP treatment and Santoyo knew this.
ATC was engaged in this fraudulent activity with not only patient recruiters but assisted living facilities and halfway houses as well. The company paid millions of dollars in kickbacks for these ineligible patients. The company got the funds for the bribes by laundering millions of dollars from Medicare payments.
ATC's managers and owners, as well as doctors, therapists and others involved have already pleaded guilty or have been convicted at trial. ATC's owner, Lawrence Duran, was sentenced to 50 years in prison in September 2011 as the mastermind of the whole scheme.
Falsely recruiting patients is a frequent tactic used by those engaged in healthcare fraud. The fraud can take the form of the recruiter providing ineligible patients as in this case or very often the recruiter pays the patients to allow a provider to bill Medicare for products or services never furnished. South Florida has been a hotbed of this type of activity during the past several years.
The MFSF has been a success story for the Obama administration. Since it began operations in March 2007, the MFSF has accused more than 1,700 people of a total of $5.5 billion of fraudulent billings to the Medicare program. The MFSF is a joint operation of federal, state and local investigators coordinated by the Justice Department (DOJ) and the Department of Health and Human Services (HHS).
The HHS and DOJ created the Health Care Fraud Prevention and Enforcement Action Team (HEAT) in May 2009 to make Medicare fraud and Medicaid fraud a cabinet-level assignment. HEAT's work is directed by the HHS Secretary and by the U.S. Attorney General. HEAT was responsible, in 2011, for making the largest federal health care fraud case ever made. It involved more than a half of billion dollars in fraudulent billing.
The MFSF has been so successful that it soon expanded to nine cities from its origins in South Florida, Los Angeles, Houston and Detroit. It currently serves Baton Rouge, Brooklyn, Chicago; Dallas, Detroit, Michigan, Houston, Texas, and Los Angeles as well as Florida's Miami, Dade Tampa Bay.