Medicare Fraud a High Dollar Worry

From inside medical centers and through outside medical and therapy practices, multi-millions of dollars are being fraudulently taken but government prosecutors are getting tougher.

During just a two week period of time in November and just looking at the Miami area, there have been significant developments.

For instance, a registered nurse and a former program coordinator pleaded guilty in connection with a healthcare fraud scheme involving defunct health provider Health Care Solutions Network Inc. (HCSN).

John Thoen of Miami pleaded guilty before U.S. District Judge Cecilia Altonaga to conspiracy to commit healthcare fraud and conspiracy to commit money laundering. Alexandra Haynes of Taylor, S.C., pleaded guilty to one count of conspiracy to commit healthcare fraud in the same case.

According to court documents, HCSN operated community mental health centers at three locations in Miami-Dade County, Fla., and one location in Hendersonville, N.C. HCSN purported to provide partial hospitalization program (PHP) services to individuals suffering from mental illness. A PHP is a form of intensive treatment for severe mental illness.

In a separate action, a federal jury convicted a Miami-area program director and a Miami-area therapist for their participation in a Medicare fraud scheme involving more than $205 million in fraudulent billings by mental healthcare corporation American Therapeutic Corporation (ATC). Evidence at trial demonstrated that the defendants and their co-conspirators caused the submission of false and fraudulent claims to Medicare through ATC, which operated purported PHPs in seven different locations throughout South Florida and Orlando.

Bill was the editor emeritus of Security Magazine, and he can be reached at (773) 929-6859.

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