October 21, 2013 — Each year, the U.S. Justice Department counts on tips from whistleblowers to recover millions of dollars that could otherwise be lost on phony Medicare scams. The qui tam provisions in the False Claims Act arm health care insiders with the tools necessary to help combat fraud in their industry. In return for filing a claim on the government’s behalf, informants keep a portion of any proceeds from the suit. Health care employees are ideally situated to notify the government concerning unethical health care providers.
Florida Residents Indicted in Alleged $190 Million Medicare Fraud Scheme
Two Miami, Florida residents who were alleged patient brokers in a $190 million Medicare fraud scheme have been indicted. Between February 2006 and October 2010, Jose Martin Olivares and Mayelin Santoyo allegedly took part in a Medicare fraud scheme devised by the owners and management of American Therapeutic Corporation (ATC) and Medlink Professional Management Group Inc., ATC’s management company. The corporations are now defunct, following the arrest of their owners in October 2010.
ATC claimed to operate partial hospitalization programs (PHPs) in seven Florida locations for patients with severe mental illness. Olivares and Santoyo allegedly recruited patients for ATC, who were ineligible for treatment under Medicare guidelines. For example, some recruited patients were suffering from dementia or mental retardation, not mental illness. ATC allegedly billed Medicare for treating those patients.
In exchange for the referrals, Olivares and Santoyo allegedly were paid kickbacks, either by check or cash. The amount of the kickbacks was directly tied to the number of days spent by the recruited patients at ATC. Over the course of the Medicare fraud scheme, ATC allegedly paid millions of dollars in kickbacks to patient recruiters like Olivares and Santoyo. Many of those involved in the conspiracy have already pleaded guilty or have been convicted at trial.
Conscientious Health Care Employees Key to Ending Medicare Fraud
False Claims Act violations involving kickbacks and phony Medicare claims frequently are uncovered by health care employees. Tipsters willing to collaborate with the Justice Department need to understand how the process works before moving forward. The qui tam attorneys with Waters & Kraus offer conscientious informants the legal representation they deserve. Send us an email or call our False Claims Act attorneys at 855.784.0268 to find out more about our whistleblower practice.