The co-owner of American Therapeutic Corp., a 40 year old Miami woman, has been sentenced to 35 years in prison and ordered her and her associates to pay back $87 million in restitution. This Medicare fraud sentence comes close on the heels of the 50 year sentence received by fellow owner Lawrence Duran last week. The woman pleaded guilty to 21 felony counts for her role in operating the mental health company.

Over an eight year period, American Therapeutic Corp. submitted roughly $205 million in improper claims to Medicare. The company would bribe people or pay recruiters kickbacks to get Medicare patients to undergo expensive treatments for mental illness. The treatments were generally not indicated or were completely unnecessary, according to law enforcement personnel. The company, as well as a related company, American Sleep Institute, then engaged in money laundering and other illegal actions designed to avoid detection.

The cases involving American Therapeutic and its employees are a part of the Medicare Fraud Strike Force, created in 2007 to catch and prosecute people accused of health care fraud. A significant portion of these efforts have been directed at South Florida health care professionals.

Many measures have been proposed to reduce Medicare fraud and to protect the patients and providers who rely on the system. A lack of oversight and confusion surrounding the Medicare system has led to serious problems. Law enforcement now seems intent on making an example out of a few, in the hopes that it will deter the many people who submit improper claims through Medicare. This sentence is the latest example of the harsh penalties faced by anyone charged with health care fraud.

Source: The Wall Street Journal, “Miami Woman Gets 35-Year Prison Term For $205M Medicare Fraud,” Joan E. Solsman, 19 September 2011

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