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Guilty Plea Entered In Health Care Fraud Case

The Miami office of the Federal Bureau of Investigation and the U.S. Justice Department announced that two more people have pleaded guilty in connection with the Health Care Solutions Network Inc. health care fraud scheme. The two people, a licensed therapist and clinic director, along with a registered clinical social worker intern, entered guilty pleas to single counts of conspiracy to commit health care fraud.

HCSN operated mental health centers in three locations. The company and several individuals associated with the company have been accused of paying kickbacks to assisted living facilities in exchange for personal information about the facilities' occupants. The information was used to submit false claims to Medicare and Medicaid, pretending that HCSN had provided intensive mental health treatments under its Partial Hospitalization Program.

Documents provided to the court showed that the clinic director knew about the kickbacks and knew that many of the patients who allegedly received services were not eligible for PHP services. Many of the patients of the assisted living facilities suffered from mental retardation, dementia or Alzheimer's disease, which would render PHP ineffective. It was also revealed that the man knew that HCSN was falsifying patient medical records to support the fraudulent billing to Medicare and Medicaid.

HCSN has been tied to roughly $63 million in fraudulent claims made to government sponsored health care benefit programs. The owner of the company was recently sentenced to 168 months in prison. He was one of 15 people who have been charged in connection with the company's activities, 12 of whom have pleaded guilty.

Source: FBI press release, "Health Care Clinic Director Pleads Guilty in Miami for Role in $63 Million Health Care Fraud Scheme," 7 March 2013

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