Last month, a “patient broker” was sentenced to 18 months in prison for his part in a conspiracy to commit Medicare fraud that resulted in huge financial losses to the Medicare system. Jean-Luc Veraguas, who worked for a number of health care providers plead guilty in May, admitting that he accepted illegal kickbacks in exchange for sending patients to American Therapeutic Corporation for Medicare-funded treatment who were not eligible for coverage.
American Therapeutic was a chain of mental health clinics in South Florida that ran partial hospitalization programs that treated severe mental illness. Among the services provided were expensive group therapy sessions. Veraguas worked for American Therapeutic to help direct new clients into the treatment program, even those who were not appropriate for the treatments the company provided. For instance, patients with Alzheimer’s and dementia were signed up for treatment, paid for by Medicare, even though the group’s expensive therapy program could be of no use to them.
ATC also paid kickbacks to a number of assisted-living facilities in South Florida to provide ineligible patients. Executives and employees at ATC would then, in turn, falsify medical records to get their Medicare claims processed. After receiving the payments, ATC would then often not provide the treatments. So far, over 20 individuals have pleaded guilty or been found guilty at trial for their roles in the enormous scheme, which is estimated to have cost taxpayers over $200 million in bogus payments to ATC and other health care providers who took part in the conspiracy.
Medicare covers the bulk of medical expenses for America’s seniors, but the integrity of the system depends on coverage of only those medical procedures and costs that are medically necessary. Schemes like those involving “patient brokers” like Veraguas fraudulently burden the system with high-cost medical care that serves no legitimate purpose. When healthcare providers use patient brokers or pay kickbacks to nursing homes, therapists, or physicians through referral agreements, they run the risk that these financial relationships will violate federal law. Such agreements—even where they do not falsify medical records as ATC did—have the natural effect of causing patients to receive treatment for reasons other than legitimate medical needs. While these agreements are unethical in any case, when the patient’s care is reimbursed by the government through Medicare or Medicaid, the agreements violate federal law.
Individuals with information about these types of illegal kickback schemes that defraud federal healthcare programs should contact an experienced whistleblower attorney. The False Claims Act carries harsh penalties for those who defraud the federal government and provides generous awards to whistleblower who uncover fraud that leads to recovery of taxpayer dollars.