The legal fallout from the activities of the mental health care company American Therapeutic Corporation continued this week, as a Miami-area therapist was sentenced to 48 months in prison. The Medicare fraud scheme has been connected to $205 million in improper Medicare payments. The sentence was handed down in the Southern District of Florida.
Individuals associated with ATC have been implicated in a massive scheme to bill Medicare for services that were never rendered and for which the "patients" involved would not qualify. ATC claimed it was providing partial hospitalization programs for sufferers of severe mental illness. The company was paying kickbacks to the owners of assisted living facilities and halfway houses to steer people to the programs. Few, if any, of these people were eligible for this form of treatment and they were not actually treated.
In her role in the scheme, the Miami therapist would falsify notes and other documents, as well as instructing others to do the same, to make it seem as though the patients were eligible and were receiving the treatment. Those patient files were used to support the fraudulent Medicare claims at the heart of ATC's business.
In 2011, ATC pled guilty to conspiracy to commit health care fraud. Since then, many individuals associated with the business have been tried for health care fraud. In addition to the prison sentence, the therapist was held liable, jointly and severally to pay more than $72 million in restitution.
Source: Federal Bureau of Investigation, "Miami-Area Therapist Sentenced to Prison in Florida in $205 Million Community Mental Health Fraud Scheme," 28 January 2013