Nearly Five Years for Medicare Fraud

(CN) - The owner of a Miami-area transportation company was sentenced to four years and nine months in federal prison for a Medicare fraud kickback scheme that funneled patients through a fraudulent mental health company, American Therapeutic Corp.

Isabel Roque, 55, was also ordered to pay $3.8 million in restitution.

Roque pleaded guilty in November in Miami Federal Court to conspiracy to commit health care fraud. She was president of Isa & Yami Inc., which purported to provide patient transportation services.

The Justice Department said Roque agreed to provide Medicare beneficiaries to four of American Therapeutic Corp.'s South Florida facilities for partial hospitalization services in exchange for kickbacks.

Partial hospitalization services (PHPs) are a form of intensive treatment for patients with severe mental illness. American Therapeutic Corp. (ATC) operates PHPs at seven sites in South Florida and Orlando.

Prosecutors say Roque admitted that she knew the beneficiaries whom she referred to ATC did not need PHP treatment and that ATC fraudulently billed Medicare for the services.

Roque also paid kickbacks to patients she referred, and ATC paid kickbacks to owners and operators of assisted living facilities and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and its related company, the American Sleep Institute, the Justice Department said in a statement.

"In some cases, the patients received a portion of those kickbacks. Throughout the course of the ATC conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries who did not qualify for PHP services," prosecutors said. "The ineligible beneficiaries attended treatment programs that were not legitimate so that ATC and ASI could bill Medicare more than $200 million in medically unnecessary services."

In her plea agreement, Roque admits her participation in the fraud resulted in more than $3.8 million in fraudulent billing to Medicare.

ATC, its management company Medlink Professional Management Group, and various owners, managers, doctors, therapists, patient brokers and marketers of ATC, Medlink and ASI, were charged with health care fraud, kickback, money laundering and other offenses in two indictments unsealed on Feb. 15, 2011.

ATC, Medlink and nine individual defendants have pleaded guilty or were convicted at trial. More defendants are scheduled for trial on April 9.

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