Billy Denica, who owns an assisted living facility near Miami called Robyll Care Assisted Living Facility, recently pleaded guilty to one count of conspiracy to commit health care fraud. Denica was involved in a scheme that directed patients to American Therapeutic Corporation (ATC), a fraudulent mental health care provider, in exchange for illegal kickbacks.
The Department of Justice announcement describes an illegal operation that seemingly had something for everyone involved. Denica funneled Medicare beneficiaries who lived at her Robyll facility to ATC for alleged mental health treatments, which are known in the industry as partial hospitalization program (PHP) services. Court documents report that Denica knew ATC was fraudulently billing Medicare for treatment of the Robyll patients. ATC paid kickbacks to Denica in exchange for the referrals.
ATC claimed to run PHPs in seven Florida locations, but allegedly was more in the business of fraudulently billing Medicare for mental health services than in actually providing necessary services. Some of Denica’s residents at Robyll were allegedly paid off with cash, candy or cigarettes as an enticement to consent to be admitted to the hospital so they could later receive unnecessary mental health treatment at ATC.
Denica’s role in the scheme caused over $1.1 million in phony billings by ATC to Medicare, according to her plea agreement. ATC and a number of persons and entities associated with it have also pleaded guilty, been convicted or are awaiting trial on related charges.
Many cases of health care fraud similar to this one are reported by employees or patients pressured to take part in the fraud or to keep quiet about it. These brave whistleblowers play an important role in saving taxpayer dollars and bringing wrongdoers to justice. To encourage people to come forward and reward them for speaking out, the qui tam provisions of the federal False Claims Act allow a whistleblower to share in any recovery by the government.
Waters & Kraus is a national firm with highly skilled lawyers practicing qui tam litigation in four offices, including Dallas, Los Angeles, San Francisco, and Baltimore. Our attorneys have decades of experience successfully representing whistleblowers in a variety of fraud cases. Contact us or call our attorneys at 800.226.9880 to learn more about our practice and how we can assist.
