United States District Court, S.D. Florida
U.S.C. § 1349, 18 U.S.C. § 1347, 18 U.S.C. §
371, 18 U.S.C. § 1956(h), 18 U.S.C. § 1957, 18
U.S.C. § 1956(a), 31 U.S.C. § 5324(a), (d), 18
U.S.C. § 2, 18 U.S.C. § 982
WIFREDO A. FERRER UNITED STATES ATTORNEY SOUTHERN DISTRICT OF
BOND WALTHER DEPUTY CHIEF CRIMINAL DIVISION, FRAUD SECTION
U.S. DEPARTMENT OF JUSTICE
JENNIFER L. SAULINO MARIA GONZALEZ CALVET TRIAL ATTORNEYS
CRIMINAL DIVISION, FRAUD SECTION U.S. DEPARTMENT OF JUSTICE
Grand Jury charges that:
times relevant to this Indictment, 1. The Medicare Program
("Medicare") is a federal health care program
providing benefits to persons who were over the age of
sixty-five or disabled. Medicare is administered by the
Centers for Medicare and Medicaid Services ("CMS"),
a federal agency under the United Stales Department of Health
and Human Services. Individuals who receive benefits under
Medicare are referred to as Medicare
"beneficiaries." Medicare is a "health care
benefit program, " as defined by Title 18, United States
Code, Section 24(b).
B of the Medicare program covers partial hospitalization
programs ("PHPs") connected with the treatment of
mental illness. The treatment program of PHPs closely
resembles that of a highly structured, short-term hospital
inpatient program, but it is a distinct and organized
intensive treatment program that offers less than 24-hour
daily care and is designed, in part, to reduce medical costs
by treating qualifying individuals outside the hospital
Under the PHP benefit. Medicare covers the following
services: (1) individual and group therapy with physicians or
psychologists (or other authorized mental health
professionals); (2) occupational therapy; (3) services of
social workers, trained psychiatric nurses, and other staff
trained to work with psychiatric patients; (4) drugs and
biologicals furnished for therapeutic purposes that cannot be
self-administered; (5) individualized activity therapies that
are not primarily recreational or diversionary; (6) family
counseling (for treatment of the patient's condition);
(7) patient training and education; and (8) diagnostic
Medicare generally requires that the PUP be provided at a
facility that is hospital-based or hospital-affiliated, but
Medicare also allows a PHP to be provided in a Community
Mental Health Center ("CMHC"), which is a provider
type under Part A of Medicare.
Medicare requires that, to qualify for the PHP benefit, the
services must be reasonable and necessary for the diagnosis
and active treatment of the individual's condition. The
program also must be reasonably expected to improve or
maintain the condition and functional level of the patient
and to prevent relapse or hospitalization. The program must
be prescribed by a physician and furnished under the general
supervision of a physician and under an established plan of
treatment that meets Medicare requirements.
Typically, a patient who needs this intensive PHP treatment
has a long history of mental illness that has been treated.
Patients are ordinarily referred either (a) by a hospital
after Ml inpatient hospitalization for severe mental illness
or (b) by a doctor who is trying to prevent full inpatient
hospitalization for a severely mentally ill patient the
doctor has been treating.
Medicare guidelines specifically exclude meals and
transportation from coverage under the PHP benefit.
Medicare does not cover programs involving primarily social,
recreational, or diversionary activities.
order to receive payment from Medicare, a CMHC, medical
clinic or physician is required to submit a health insurance
claim form to Medicare, called a Form 1450. The claims may be
submitted in hard copy or electronically. A CMHC, medical
clinic, and physician may contract with a billing company to
transmit claims to Medicare on their behalf.
Part B of the Medicare program also covers diagnostic sleep
studies conducted at sleep disorder clinics. Medicare covers
all reasonable and necessary diagnostic tests given for
certain medical conditions when the clinic is affiliated with
a hospital or is under direction and control of physicians;
when patients are referred to the sleep disorder clinic by
their attending physicians and the clinic maintains a record
of the attending physician's orders; and the need for
diagnostic testing is confirmed by medical evidence such as
physician examinations and laboratory tests. In particular,
Medicare pays for sleep studies if the patient has symptoms
or complaints of one of the following conditions, and only
under certain limited circumstances: narcolepsy, sleep apnea,
impotence, and parasomnia. Chronic insomnia is not covered.
order to receive payment from Medicare, a sleep disorder
clinic is required to submit a health insurance claim form to
Medicare, called a Form 1500. The claims may be submitted in
hard copy or electronically. A sleep disorder clinic may
contract with a billing company to transmit claims to
Medicare on their behalf.
Medicare Part B is administered in Florida by First Coast
Service Options ("FCSO"), which, pursuant to
contract with the United States Department of Health and
Human Services, serves as a contracted carrier to receive,
adjudicate and pay Medicare Part B claims submitted to it by
Medicare beneficiaries, physicians, or CMHCs. Medicare Part B
pays CMHCs and physicians directly for the cost of PHP
services furnished to eligible Medicare beneficiaries,
provided that the services meet Medicare requirements.
Relevant Entities, and Relevant Persons
American Therapeutic Corporation ("ATC") was a
Florida corporation originally established in 2002 and was
headquartered in Miami, Florida, ATC operated several
purported PHPs throughout Florida from Homestead to Orlando,
including PHPs at the following addresses: 1801 NE
2"" Avenue, Miami, Florida 33132; 61 Grand Canal
Drive, Suite #100, Miami, Florida 33144; 1001 West Commercial
Blvd., Fort Lauderdale, Florida 33309; 4960 North Dixie
Highway, Fort Lauderdale, Florida 33334; 27112 South Dixie
Highway, Naranja, Florida 33032; 717 East Palmetto Park Road,
Boca Raton, Florida 33432; and 4790 North Orange Blossom
Trail, Orlando, Florida 32810.
Medlink Professional Management Group, Inc.
("Medlink") was a Florida corporation established
in 2003 and was headquartered at 484 Brickell Avenue, Suite
1220, Miami, Florida 33132 and later at 1809 NE
2nd Avenue, Miami, Florida 33132. Medlink was used
to charge monthly fees to ATC for managing ATC's
operations, including hiring employees, running daily
operations, and controlling finances and other site
American Sleep Institute ("ASI") was a Florida
corporation established in 2005 and was headquartered in
Miami, Florida at the offices of Medlink. ASI was later
headquartered in Hialeah, Florida. ASI purportedly provided
sleep study services.
Defendants MARK WILLNER, MD, a resident of Miami-Dade County,
ALAN GUMER, MD, a resident of Broward County, and ALBERTO
AYALA, MD, a resident of Miami-Dade County, were physicians
licensed in the State of Florida and were medical directors
at ATC and referring physicians to ASI.
Defendants VANJA ABREU, Ph.D, a resident of Broward County,
NANCY MERCED-SOLA, a resident of Orange County, and LYDIA
WARD, Ph.D, a resident of Miami-Dade County, were
"program directors" at ATC.
Defendant NICHOLE ECKERT, a resident of Miami-Dade County,
was a therapist at ATC.
Defendants SANDRA JIMENEZ, a/k/a Sabrina Jimenez, and HILARIO
MORRIS, a/k/a Larry Morris, residents of Miami-Dade County,
and JOSEPH VALDES, a/k/a Joseph Valdez, a resident of Broward
County, were "marketers" for ATC who would pay and
cause the payment of kickbacks in exchange for Medicare
beneficiaries to attend ATC and ASI.
Defendant ADRIANA MEJIA, a resident of Miami-Dade County,
cashed checks for MEDLEVK and was the owner of multiple
companies used to conceal the illicit conversion of checks
into cash. Those companies included Andorra Printer Designs,
Computer Resources Management Review Company, Pulp &
Paper Company, Stamina Company, and FKEE OF
Defendant _____ resident of Miami-Dade County, cashed checks
for MEDLINK and was a co-owner of _____ used by himself and
others to conceal the illicit conversion of checks into cash,
22. Defendants PEDRO SOSA, a resident of Miami-Dade County,
and YOISEL CANCIO, a resident of Miami-Dade County, cashed
checks for MEDLINK and used companies such _____ to conceal
the illicit conversion of checks into cash.
Defendants MATHIS MOORE, NELSON FERNANDEZ, and LEYANES
PLACERES, residents of Miami-Dade County, JAMES EDWARDS, a
resident of Broward County, FRANK CRIADO, a resident of
Miami-Dade County, and CURTIS GATES, a resident of Broward
County, were patient brokers who worked with ATC, ASI, and
Medlink to funnel ineligible patients into their PHP programs
and sleep studies in exchange for kickbacks.
Lawrence S. Duran, a resident of Miami-Dade County, was the
manager and owner of ATC and Medlink. Duran was also the
registered agent for ASI.
Marianella Valera, a resident of Miami-Dade County, was the
owner, CEO, president, secretary and treasurer of ATC. Valera
was also the vice president of ASI.
Judith Negron, a resident of Miami-Dade County, was the vice
president and part owner of Medlink and owner and president
Margarita Acevedo, a/k/a Margarita De La Cruz, a resident of
Miami-Dade County, was the Marketing Director of ATC. Acevedo
supervised ATC's marketers but worked for Medlink.
to Commit Health Care Fraud (18 U.S.C. § 1349)
Paragraphs 1 through 19 and 23 through 27 of the General
Allegations section of this Indictment are realleged and
incorporated by reference as though fully set forth herein.
on or about December 13, 2002, through on or about October
21, 2010, in Miami-Dade County, in the Southern District of
Florida, and elsewhere, the defendants,
MARK WILLNER, MD,
ALAN GUMER, MD, ALBERTO AYALA, MD,
VANJA ABREU, Ph.D,
LYDIA WARD, Ph.D,
SANDRA JIMENEZ a/k/a Sabrina Jimenez,
HILARIO MORRIS a/k/a Larry Morris,
JOSEPH VALDES a/k/a Joseph Valdez,