Doctors approved fake patient charts in $200M Medicare fraud plot

Twenty people, including three medical doctors and two PhDs, were indicted in Florida for a mix of healthcare fraud, kickback and money laundering charges that were part of their alleged role in a $200 million Medicare fraud plot for supposed mental health services, the Department of Justice and HHS announced yesterday.

According to the 38-count indictment, which supersedes a 13-count indictment from October 2010, the defendants reportedly worked with and for American Therapeutic Corporation and Medlink Professional Management Group Inc.

They were part of an elaborate scheme to bilk Medicare by submitting fake claims for mental health services administered at ATC facilities. The services either were not medically necessary, or were not provided at all. The indictment claims that various defendants paid kickbacks to patient brokers and owners or operators of halfway houses and assisted living facilities in return for patients delivered to ATC facilities.

As part of the plot, patient charts and notes from therapy sessions at ATC were altered to create the illusion that patients being treated qualified for partial hospitalization programs (PHPs), a form of intensive treatment for mental illness. ATC operated purported PHPs at seven sites in Florida.

Three doctors, according to the indictment, signed fake patient charts authorizing unneeded or continued treatment for patients who were not eligible for PHP--without examining the patients or the charts. The doctors not only altered diagnoses and medication types to make it seem like the patients qualified for PHP, they also manipulated the length of the patient stays to maximize the number of days they could get Medicare to pay for such treatments.

"As today's charges reflect, defrauding the Medicare system was not an aberration at ATC, but instead part and parcel of its business operations," Assistant Attorney General Lanny A. Breuer of the Criminal Division of the Justice department said in a statement. He characterized the scheme as brazen in scope.

 Justice Department officials have called the scam the largest fraudulent billing plot ever prosecuted by a healthcare fraud strike force.

To learn more:
- read the DoJ press release

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