$63 Million Medicare Fraud Scheme Lands Seven People with Health Care Fraud Charges
A psychiatrist, who has been practicing in Miami since the 1970’s, along with six psychologists, have been indicted on health care fraud charges for planning to defraud the Medicare program of $63 million.
Roger Rousseau, 71 years old, is the former director of the now defunct Health Care Solutions Network (HCSN) in Florida, and was indicted on health care fraud charges on July 11th. He and six therapists that worked for him – Doris Crabtree, 61; Angela Salafia, 65; Liliana Marks, 46; Ruben Busquets, 49; Alina Fonts, 47; and Blanca Ruiz, 59 – were each charged with conspiracy to commit health care fraud. In addition, Rousseau received charges of two counts of health care fraud. Fonts was also charged with two counts of health care fraud, and Crabtree, Salafia, Marks, and Busquets were each charged with two counts of making false statements related to health care matters.
Rousseau made his first appearance in federal court, along with the other six defendants, on Tuesday, July 16th. He was released on a $375,000 bond.
The health care fraud charges stem from a much larger health care fraud scheme run by HCSN owner Armando “Manny” Gonzalez, a 50-year-old previously-convicted cocaine trafficker, who was sentenced to 14 years in federal prison in February for health care fraud charges. He reportedly had branches of HCSN in both Florida and North Carolina, moving the operation up to NC to stay a step ahead of federal agents. Between 2004 and 2011, according to court documents, Gonzalez stole $28 million in false Medicare and Medicaid billings for psychotherapy sessions that patients did not need or did not receive.
Dozens of other people have been indicted on health care fraud charges related to Gonzalez’s arrest, including patient recruiters, facility operators, and assisted living facility owners, who accepted kickbacks for supplying Medicare and Medicaid beneficiaries. Nearly all of those indicted since last year have gone to court and pled guilty to health care fraud charges. The case against Rousseau and his Florida branch of the network is only the latest spin-off case.
The indictment against Rousseau states that he routinely signed fabricated medical records with full knowledge that they were falsified, and never reviewed the materials or met with the patients himself. The indictment alleges that his six colleagues falsified the records to back up Medicare and Medicaid payments for psychotherapy services. As many of their patients suffered dementia or Alzheimer’s, the therapy sessions would not have been beneficial.
The health care fraud case is still being investigated by the FBI and HHS-OIG, and was brought forth as part of the Medicare Fraud Strike Force.
Health Care Fraud Charges in South Carolina
Health care fraud results from an individual defrauding an insurer or government health care program. Health Care Fraud encompasses a variety of fraudulent acts.
These acts include:
- Billing for services not provided; this usually involves the billing of services not provided by the physician or medical official to the patient.
- Up coding of services; this usually involves the billing for services more expensive then the services actually provided.
- Up coding of items; this is similar to up coding of services, but involves the up selling of medical equipment.
- Duplicating claims; this typically involves the changing of a date on a claim and rebilling for the same services provided, just using a different date.
- Unbundling; this typically involves billing of services separately, resulting in a higher pay out than if it was billed together.
- Excessive services; this includes the billing of services and equipment greater than the level of actual services required.
- Unnecessary services; this involves the billing of services that were not necessary for the condition being treated.
- Kickbacks; this involves the receiving of gifts or services by the doctor or medical professional to entice the use of specific medical services or drugs.
The FBI estimates healthcare fraud costs the United States upwards of $80 billion a year. The FBI is the primary investigator of health care fraud claims.
The Strom Law Firm Protects Health Care Fraud Whistleblowers
If you have first-hand knowledge of government or healthcare fraud occurring at your place of employment or your doctor’s office, the attorneys at the Strom Law Firm can help protect your rights. In order to help the government provide the best possible services, Medicaid, Medicare, and healthcare fraud must be reported as soon as possible. The attorneys at the Strom Law Firm understand the complexity of qui tam and whistleblower suits, and we offer free, confidential consultations to discuss the facts of your case. Contact us today.803.252.4800
