Vulnerable individuals had their identity information sold by sleazy assisted living facilities employees to others who used it for Medicare and Medicaid fraud.
A former health care clinic director and licensed therapist both pleaded guilty yesterday in connection with a health care fraud scheme involving defunct health provider Health Care Solutions Network Inc. (HCSN).
Paul Thomas Layman, 66, of Miami, pleaded guilty before U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida to one count of conspiracy to commit health care fraud. Layman’s co-conspirator Dana Gonzalez, 43, of Miami, a registered clinical social worker intern in Florida, pleaded guilty to one count of conspiracy to commit health care fraud for her role in the scheme.
During the course of the conspiracy, Layman was employed as a substance abuse counselor, therapist and clinical director of HCSN’s Partial Hospitalization Program (PHP).
In Florida, HCSN operated community mental health centers at three locations. During his employment, Layman worked full time at all HCSN locations in Florida in various capacities. According to court documents, Layman was aware that HCSN in Florida paid illegal kickbacks to owners and operators of Miami-Dade County Assisted Living Facilities (ALF) in exchange for patient referral information to be used to submit false and fraudulent claims to Medicare and Medicaid. Layman also knew that many of the ALF referral patients were ineligible for PHP services because many patients suffered from mental retardation, dementia and Alzheimer’s disease.
Court documents reveal that Layman was aware that HCSN personnel in Florida were fabricating patient medical records. Many of these medical records were created weeks or months after the patients were admitted to HCSN facilities in Florida for purported PHP treatment and were utilized to support false and fraudulent billing to government sponsored health care benefit programs, including Medicare and Florida Medicaid. During his employment at HCSN in Florida, Layman signed fabricated PHP therapy notes and other medical records used to support false claims to government sponsored health care programs.
HCSN also operated one location in Hendersonville, N.C. At the Hendersonville location, Layman served as the clinical director and assisted HCSN owner Armando Gonzalez in obtaining necessary licensing, credentials and Medicare authorizations for HCSN. According to court documents, from 2008 through 2009, Layman purportedly supervised therapists at HCSN in Hendersonville, including Alexandra Haynes, who was an unlicensed therapist purportedly performing PHP therapy to HCSN patients. For their roles in the conspiracy, Gonzalez pleaded guilty to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering, and Haynes pleaded guilty to one count of conspiracy to commit health care fraud. On Monday, Feb. 25, 2013, Gonzalez was sentenced to serve 168 months in prison for his role in the scheme.
According to court documents, Dana Gonzalez worked at HCSN in Florida from approximately April 2005 through December 2010. At HCSN in Florida, Gonzalez fabricated patient medical records, which were used to support false and fraudulent billing to Medicare and Florida Medicaid. In 2011, Gonzalez worked at HCSN in North Carolina, where she fabricated therapy notes and medical records, and provided unlicensed therapy when licensed therapists were absent.
According to court documents, from 2004 through 2011, HCSN billed Medicare and the Florida Medicaid program approximately $63 million for purported mental health services.
Fifteen defendants have been charged for their alleged roles in the HCSN health care fraud scheme, and 12 defendants have pleaded guilty. Alleged co-conspirator Wondera Eason is scheduled for trial on April 22, 2013, before Judge Altonaga in Miami. Alleged co-conspirators Alina Feas and Lisset Palmero are scheduled for trial on June 3, 2013. Defendants are presumed innocent until proven guilty at trial.
The cases are being prosecuted by Special Trial Attorney William Parente and Trial Attorneys Allan J. Medina and Steven Kim of the Criminal Division’s Fraud Section. This case is being investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.
I wonder if any of the ALF employees who provided the information to HCSN were charged and/or convicted for their role.
Source: Department of Justice