Kusserow’s Corner: Six Individuals in Florida Indicted for Roles in $63 Million Fraud

On July 16, 2013, the DOJ announced the that the former medical director at defunct Florida health provider Health Care Solutions Network (HCSN) and six therapists were arrested, accused of conspiring to fraudulently bill Medicare and Florida Medicaid more than $63 million. The arrests were made after the indictment was unsealed. The former HCSN medical director was indicted on charges of conspiracy to commit health care fraud and two counts of health care fraud.  The indicted six therapists from Miami were also charged in the same indictment with conspiracy to commit health care fraud. Additional charges included with health care fraud, and making false statements related to health care matters. The indictment also seeks forfeiture of proceeds from the alleged healthcare fraud offenses.

According to the indictment, HCSN purported to provide intensive mental health treatment to Medicare and Medicaid beneficiaries in Miami and Hendersonville, N.C., from approximately 2004 through 2011 for purported mental health services that were not medically necessary and often never provided; and paid kickbacks to assisted living facility owners and operators who, in exchange, referred beneficiaries to HCSN. In total, HCSN is alleged to have fraudulently billed Medicare and Medicaid approximately $63.7 million, from which HCSN allegedly received payments totaling approximately $28 million.  The HCSN medical director in Florida is alleged to have routinely signed what he knew to be fabricated and altered medical records without ever reviewing the materials, and, in most instances, without ever meeting with the patient. The indictment also alleges that HCSN staff falsified medical records to support false and fraudulent claims for partial hospitalization program services that were not medically necessary and were not provided.

 

Richard P. Kusserow served as DHHS Inspector General for 11 years.  He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters.  The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

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Copyright © 2013 Strategic Management Services, LLC.  Published with permission.