WASHINGTON—A Miami-area resident pleaded guilty today for his role in structuring monetary transactions to provide cash for the furtherance of a fraud scheme that resulted in the submission of more than $200 million in fraudulent claims to Medicare, announced the Department of Justice, the FBI, and the Department of Health and Human Services (HHS).

Lazaro Acosta, 41, pleaded guilty before U.S. District Judge Patricia A. Seitz in Miami to one count of currency structuring to avoid reporting requirements. Acosta admitted that he structured currency transactions to avoid reporting requirements so he could provide $2.4 million in cash to the owners and operators of American Therapeutic Corporation (ATC); its management company, Medlink Professional Management Group Inc.; and the American Sleep Institute (ASI).

On March 21, 2012, Acosta’s co-defendant, Leyanes Placeres, 31, pleaded guilty before U.S. Magistrate Judge Andrea Simonton in Miami to one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the United States and to pay and receive illegal health care kickbacks. Placeres admitted that she participated in the fraud scheme orchestrated by the ATC, Medlink, and ASI owners and operators. Placeres and Acosta were both charged in an indictment unsealed on February 15, 2011 in the Southern District of Florida.

ATC, Medlink, and ASI were Florida corporations headquartered in Miami. ATC operated purported partial hospitalization programs (PHPs) in seven different locations throughout South Florida and Orlando. A PHP is a form of intensive treatment for severe mental illness. ASI purported to provide diagnostic sleep disorder testing.

According to court filings, ATC’s owners and operators 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 ASI. In some cases, the patients received a portion of those kickbacks. Throughout the course of the ATC and ASI conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries to attend illegitimate treatment programs so that ATC and ASI could bill Medicare for medically unnecessary services. According to court filings, to obtain the cash used to pay the kickbacks, the co-conspirators laundered millions of dollars of payments from Medicare and structured their transactions to avoid detection by bank officials and the authorities.

In pleading guilty, Acosta admitted that he worked with Lawrence Duran, one of the owners and operators of ATC, Medlink, and ASI, to use fake identities to create fake Medlink employees. Those fake identities were used to cash thousands of dollars of checks each week through a check cashing business co-owned by Acosta, South Dade Trade Interprises.

Placeres admitted that she served as a driver who worked with patient brokers to provide patients to ATC and ASI in exchange for kickbacks in the form of checks and cash. Placeres drove all of the patients provided by the brokers who worked with her, and she admitted to passing on kickback payments to the brokers. The amount of the kickback was based on the number of days each patient spent at ATC.

According to the plea agreements, Acosta’s structuring amounted to more than $2.4 million in structured funds, and Placeres’ participation in the ATC fraud resulted in $6.5 million in fraudulent billings to the Medicare program.

Sentencing for Acosta is scheduled for June 28, 2012. Acosta faces a maximum penalty of 10 years in prison, and he has agreed to forfeit $162,000 to the federal government. Sentencing for Placeres is scheduled for June 11, 2012. Placeres faces a maximum penalty of 15 years in prison and a $250,000 fine.

ATC, its management company Medlink Professional Management Group Inc., and various owners, managers, doctors, therapists, patient brokers, and marketers of ATC, Medlink, and ASI, were charged with various health care fraud, kickback, money laundering, and other offenses in two indictments unsealed on February 15, 2011. ATC, Medlink, and 12 other individual defendants have pleaded guilty or have been convicted at trial. Seven other defendants are scheduled for trial April 9, 2012 before Judge Seitz, and one defendant’s trial has been deferred until after June 2012. A defendant is presumed innocent unless proven guilty beyond a reasonable doubt in a court of law.

The guilty pleas were announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; John V. Gillies, Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher Dennis of the HHS Office of Inspector General (HHS-OIG), Office of Investigations, Miami Office.

The criminal case is being prosecuted by Trial Attorneys Jennifer L. Saulino, Steven Kim, and Robert Zink of the Criminal Division’s Fraud Section. A related civil action is being handled by Vanessa I. Reed and Carolyn B. Tapie of the Civil Division and Assistant U.S. Attorney Ted L. Radway of the Southern District of Florida. The case was 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.

Since its inception in March 2007, the Medicare Fraud Strike Force operations in nine locations have charged more than 1,190 defendants that collectively have billed the Medicare program for more than $3.6 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to https://www.stopmedicarefraud.gov.

Source: FBI