Two Get 85 Years in Prison for Mental Health Care Fraud

Miami and Medicare fraud. The two go hand-in-hand like a baby in a basket.

So it probably wasn’t the brightest idea for Lawrence Duran and Marianella Valera to set up a company called American Therapeutic to run a chain of seven mental health clinics in South Florida and Orlando that duped Medicare into paying out $87 million during the past decade.

It probably didn’t help that, in order to perpetuate their fraud against U.S. taxpayers, they held “charting parties” — gatherings where “they would falsify the medical records of beneficiaries to make it look like they needed therapy when they actually didn’t,” according to the Miami Herald.

In the past week, both have been given huge prison sentences — 50 years for Lawrence Duran and 35 years for mental health counselor Marianelle Valera, who will be looking to be released from prison when she’s 75 years old.

Crime doesn’t pay, not even in mental health.

The couple and their employees actually submitted $205 million in fraudulent billings to Medicare, but Medicare only paid out $87.5 million. The couple and their co-defendants were ordered to pay $87.5 million restitution while in prison (it’s not clear to me how they can do this, but whatever).

American Therapeutic was one of the nation’s largest chains of community mental health centers licensed by Medicare. It seems a lot of people were in on the scheme:

In the past year, Duran and Valera were charged along with 32 other American Therapeutic employees, psychiatrists, counselors, nurses, marketers, patient recruiters and others who supplied Medicare beneficiaries in exchange for kickbacks. American Therapeutic billed Medicare for thousands of patients, including many with dementia and Alzheimer’s disease, who had no way of benefiting from the company’s costly group-therapy sessions, prosecutors said. […]

About a dozen of the defendants have been convicted, including Duran and Valera’s top aides, Margarita Acevedo, who ran the marketing operation to bring in patients, and Judith Negron, who was in charge of a subsidiary, MedLink, which laundered Medicare profits to pay employees and kickbacks. Another employee, Joseph Valdes, who worked under Acevedo, also pleaded guilty.

According to the U.S. Department of Justice, as part of the fraud scheme, “Duran, Valera and others paid kickbacks to owners and operators of assisted living facilities and halfway houses and to patient brokers in exchange for delivering ineligible patients to American Therapeutic. In some cases, the patients received a portion of those kickbacks. The defendants and their co-conspirators actively recruited assisted living facilities and halfway house owners and operators and patient brokers to participate in the scheme.”

Duran was also a board member of the National Association of Behavioral Health (NABH), an organization begun in 2006 to lobby Congress to keep funding going for partial hospitalization programs. The kinds of programs that American Therapeutic relied on for a great deal of its income.

“In actuality, NABH was an organization that provided Duran a legitimate-looking vehicle to lobby Congress to allocate more money, through Medicare, to Duran and his co-conspirators for their fraudulent claims,” Justice Department lawyer Jennifer Saulino wrote in a recent court filing.

“He directed NABH staff to disseminate to other [community mental health centers] the tricks of his trade,” Saulino wrote, noting how he instructed others “on ways in which to win appeals of Medicare denials of claims, based on ATC’s experience.” […]

Last week, another Miami member of the lobbying organization, Biscyane Milieu Health Center, was implicated in an indictment charging its owners and about 20 others with Medicare fraud.

Oooopsie! Perhaps it’s not a good idea in hindsight to setup a lobbying group whose sole purpose is seemingly to keep the federal gravy train running.

According to news reports, these sentences are the harshest ever handed down for Medicare fraud. Ever. The previous winner was a Miami doctor who was convicted for an $11 million HIV-therapy scam and sentenced to 30 years in prison.

Kudos to the U.S. Justice Department and Justice Department lawyer Jennifer Saulino for the convictions and to U.S. District Judge James Lawrence King for handing down such stiff sentences. I hope this sends a message to others looking to defraud the government (which is ultimately you and I, since we pay for the government) — you’re going to jail for a very long time when you’re caught.

Read the full articles:

Miami couple faces lengthy sentence for Medicare fraud – Palm Beach Post

U.S. mental-health executive gets 35 years for fraud – Reuters