Another healthcare worker was sentenced this week in what is being called one of the largest medical fraud cases in U.S. history. It was a 200 million dollar medical fraud scheme, according to Modern Healthcare. About 40 people have already been convicted or pleaded guilty in connection to fraud involving a Miami-based mental health company, according to the Miami Herald.
American Therapeutic Corporation operated various mental health programs for patients with severe mental illness including dementia. Many healthcare workers affiliated with the company were accused by the Justice Department of fraudulently billing Medicare. Other companies, including American Sleep Institute, were also involved in the medical fraud ring, according to the FBI.
The fraud case made convicts out of medical professionals, including doctors, after the healthcare workers fabricated and signed fake medical paperwork and fraudulent patient files and then billed Medicare, according to the Justice Department.
An older report from Modern Healthcare detailed some of the medical fraud.
“American Therapeutic Corp. routinely claimed to have provided intensive mental illness treatments to patients whose dementia and diminished mental capacity would not have allowed them to benefit from psychological counseling.”
This week, Rodolfo Santaya, a licensed nursing assistant, joined the ranks of those sentenced in connection to the healthcare fraud scheme. Santaya was sentenced to 150 months in prison for his involvement in the healthcare fraud case. He was also ordered to pay restitution in excess of $18.2 million.
Santaya was convicted of conspiracy to commit both healthcare fraud and wire fraud. He was also convicted of conspiracy to pay and receive bribes and kickbacks and two counts of receipt of bribes and kickbacks.
Evidence presented at the trial indicated that the healthcare worker was getting thousands of dollars in kickbacks every month for referring Medicare beneficiaries to the mental health company. Many of the Medicare beneficiaries could not have benefited from, nor did they receive, the treatment their Medicare policies were billed for, according to the feds.
The 55-year-old nursing assistant was accused of recruiting patients who suffered from Alzheimer’s, dementia, and other conditions to the mental health treatment center in exchange for kickbacks. He worked at the Homestead clinic, which was one of seven clinics owned by American Therapeutic. The clinic fraudulently billed the government insurance and then failed to provide even basic care to the elderly patients, according to the Miami Herald.
“They were using trashcans as restrooms,” a federal prosecutor said at the nursing assistant’s trial.
Facing millions of dollars in restitution and 12 years in prison, he still maintains his innocence. Santaya’s lawyer said the former healthcare worker plans to appeal his convictions in the medical fraud case.
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