Miami couple pleads guilty to $200M Medicare fraud

A Miami couple has pled guilty to submitting more than $200 million in false Medicare claims, report Healthcare Finance News and the Miami Herald. Lawrence S. Duran and Marianella Valera, operators of seven clinics under the name American Therapeutics Corp., pled guilty last week to 59 separate felony counts, part of an indictment unsealed in February. The charges included conspiracy to commit healthcare fraud, healthcare fraud, conspiracy to pay and receive illegal kickbacks, money laundering and conspiracy to commit money laundering.

According to the indictments, Duran and Valera had recruited patients to receive treatments through their seven clinics, then billed Medicare for partial hospitalization care, a type of intensive therapy for mental illness. The treatments were medically unnecessary. Most of the patients suffered from Alzheimer's disease or dementia and could not benefit from the treatments.

Medicare paid claims totaling $83 million, although officials say they have recovered little more than $150,000 from the couples' bank accounts.

Another defendant in the case, American Therapeutics' marketing director Margarita Acevedo, agreed to testify against Duran and Valera as part of a plea bargain. She claims that she paid millions of dollars to recruiters who found potential patients via assisted living centers and halfway houses.

Both face as much as 20 years in federal prison when they're sentenced.

For more:
- read the Healthcare Finance News article
- read the Miami Herald article