Kusserow’s Corner: Indictments Unsealed in a $190 Million Medicare Fraud Case

On September 27, the Department of Justice (DOJ) unsealed indictments for two Miami-area residents, Mayelin Santoyo and Jose Martin Olivares, in connection with their alleged participation in a $190 million Medicare fraud scheme. They were charged with one count of health care fraud conspiracy and to receive illegal kickbacks and two counts of receiving kickbacks during the period between 2006 and 2010. The scheme was orchestrated by the owners and operators of the now-defunct American Therapeutic Corporation (ATC) and its management company, Medlink Professional Management Group Inc. (Medlink) in Miami. ATC operated purported partial hospitalization programs (PHPs), a form of intensive treatment for severe mental illness, in seven different locations throughout South Florida and Orlando.

The indictment alleges that Santoyo and Olivares served as patient brokers who provided ineligible patients to ATC in exchange for kickbacks in the form of checks and cash. The amount of the kickback was based on the number of days each recruited patient spent at ATC. Throughout the course of the ATC conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries who did not qualify for PHP services and who attended treatment programs that were not legitimate PHPs so that ATC could bill Medicare for the medically unnecessary services. According to court filings, to obtain the cash required to support the kickbacks, the co-conspirators laundered millions of dollars of payments from Medicare.

ATC, Medlink, and various owners, managers, doctors, therapists, patient brokers and marketers of ATC and Medlink have already pleaded guilty or convicted at trial in this case. The ATC owner Lawrence Duran was sentenced previously to 50 years in prison for his role in orchestrating and executing the scheme to defraud Medicare.

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.