Medicare racket cashed in on recruited patients, feds say

[Guest guest]

Medicare racket cashed in on recruited patients, feds say

February 27, 2011

Leon Ciolkowski has struggled with alcoholism for much of his life. But with that disease, the 63-year-old man was not going to qualify for costly group therapy sessions at American Therapeutic Corp.

So his Pompano Beach landord, who doubled as a patient broker for American Therapeutic, told him to pretend he suffered from a bipolar condition so he could get through the door.

American Therapeutic's clinic in Boca Raton gave him a false bipolar diagnosis, Ciolkowski said. And with his Medicare card, the company cashed in.

Altogether, the Miami-based business billed Medicare $9,110 to treat Ciolkowski for at least 29 group therapy sessions from February to April in 2009, his medical records show. They also show that the clinic regularly charged for two counseling services during each daily visit, which is not allowed under Medicare policy.

"There was no therapy," said Ciolkowski, recalling his experience at American Therapeutic. "Sometimes we would talk about our problems, but mostly we would just sit there for hours doing nothing.

"I'd see these other people urinating on themselves," he added. "Their food would be all over them. They'd just stare at the walls or sleep. They didn't know what was going on."

What happened to Ciolkowski at the American Therapeutic clinic was not an isolated instance. Federal prosecutors say it was a crime repeated over and over again with thousands of other patients as part of the nation's biggest case of mental healthcare fraud — costing the taxpayer-funded Medicare program hundreds of millions of dollars. The case has spurred criminal investigations into other mental health operators in South Florida, dubbed for years as the nation's capital of Medicare fraud.

In October, a Miami federal grand jury indicted American Therapeutic and four senior executives, accusing them of scheming to fleece $200 million from Medicare by billing for purported group counseling sessions to treat depression, schizophrenia or other mental illnesses that were either not necessary or not provided. All four officials, including the clinic chain's owner, Lawrence S. Duran, 48, have pleaded not guilty and are headed for trial in August.

Duran and two other executives were also accused of orchestrating an elaborate kickback operation involving American Therapeutic marketing employees, patient brokers, and operators of assisted-living facilities and halfway houses — which is how Ciolkowski got recruited.

This past week, the case expanded dramatically with the indictment of 20 American Therapeutic employees and others, including three physicians who prosecutors say approved patients for the majority of the company's phony claims and altered their diagnoses to qualify for Medicare payments.

Among the indicted doctors: Mark S. Willner, a Weston psychiatrist, who was paid $680,000 by American Therapeutic in exchange for approving therapy for patients implicated in $71 million worth of phony claims, prosecutors say. Willner himself billed Medicare for evaluating Ciolkowski's prescriptions, including the antipsychotic drug Seroquel for his purported bipolar disorder, the patient's records show.

American

American Therapeutic, a South Florida chain of seven clinics founded in 2000, ran its alleged scheme for years, tapping into a stream of mentally ill patients who were supposed to have received treatment in local hospitals before qualifying for outpatient group therapy sessions.

Article source: http://www.miamiherald.com/2011/02/26/2087342/medicare-racket-cashed-in-on-recruited.html

[Guest guest]

Medicare racket cashed in on recruited patients, feds say

February 27, 2011

Leon Ciolkowski has struggled with alcoholism for much of his life. But with that disease, the 63-year-old man was not going to qualify for costly group therapy sessions at American Therapeutic Corp.

So his Pompano Beach landord, who doubled as a patient broker for American Therapeutic, told him to pretend he suffered from a bipolar condition so he could get through the door.

American Therapeutic's clinic in Boca Raton gave him a false bipolar diagnosis, Ciolkowski said. And with his Medicare card, the company cashed in.

Altogether, the Miami-based business billed Medicare $9,110 to treat Ciolkowski for at least 29 group therapy sessions from February to April in 2009, his medical records show. They also show that the clinic regularly charged for two counseling services during each daily visit, which is not allowed under Medicare policy.

"There was no therapy," said Ciolkowski, recalling his experience at American Therapeutic. "Sometimes we would talk about our problems, but mostly we would just sit there for hours doing nothing.

"I'd see these other people urinating on themselves," he added. "Their food would be all over them. They'd just stare at the walls or sleep. They didn't know what was going on."

What happened to Ciolkowski at the American Therapeutic clinic was not an isolated instance. Federal prosecutors say it was a crime repeated over and over again with thousands of other patients as part of the nation's biggest case of mental healthcare fraud — costing the taxpayer-funded Medicare program hundreds of millions of dollars. The case has spurred criminal investigations into other mental health operators in South Florida, dubbed for years as the nation's capital of Medicare fraud.

In October, a Miami federal grand jury indicted American Therapeutic and four senior executives, accusing them of scheming to fleece $200 million from Medicare by billing for purported group counseling sessions to treat depression, schizophrenia or other mental illnesses that were either not necessary or not provided. All four officials, including the clinic chain's owner, Lawrence S. Duran, 48, have pleaded not guilty and are headed for trial in August.

Duran and two other executives were also accused of orchestrating an elaborate kickback operation involving American Therapeutic marketing employees, patient brokers, and operators of assisted-living facilities and halfway houses — which is how Ciolkowski got recruited.

This past week, the case expanded dramatically with the indictment of 20 American Therapeutic employees and others, including three physicians who prosecutors say approved patients for the majority of the company's phony claims and altered their diagnoses to qualify for Medicare payments.

Among the indicted doctors: Mark S. Willner, a Weston psychiatrist, who was paid $680,000 by American Therapeutic in exchange for approving therapy for patients implicated in $71 million worth of phony claims, prosecutors say. Willner himself billed Medicare for evaluating Ciolkowski's prescriptions, including the antipsychotic drug Seroquel for his purported bipolar disorder, the patient's records show.

American

American Therapeutic, a South Florida chain of seven clinics founded in 2000, ran its alleged scheme for years, tapping into a stream of mentally ill patients who were supposed to have received treatment in local hospitals before qualifying for outpatient group therapy sessions.

Article source: http://www.miamiherald.com/2011/02/26/2087342/medicare-racket-cashed-in-on-recruited.html

[Guest guest]

Medicare racket cashed in on recruited patients, feds say

February 27, 2011

Leon Ciolkowski has struggled with alcoholism for much of his life. But with that disease, the 63-year-old man was not going to qualify for costly group therapy sessions at American Therapeutic Corp.

So his Pompano Beach landord, who doubled as a patient broker for American Therapeutic, told him to pretend he suffered from a bipolar condition so he could get through the door.

American Therapeutic's clinic in Boca Raton gave him a false bipolar diagnosis, Ciolkowski said. And with his Medicare card, the company cashed in.

Altogether, the Miami-based business billed Medicare $9,110 to treat Ciolkowski for at least 29 group therapy sessions from February to April in 2009, his medical records show. They also show that the clinic regularly charged for two counseling services during each daily visit, which is not allowed under Medicare policy.

"There was no therapy," said Ciolkowski, recalling his experience at American Therapeutic. "Sometimes we would talk about our problems, but mostly we would just sit there for hours doing nothing.

"I'd see these other people urinating on themselves," he added. "Their food would be all over them. They'd just stare at the walls or sleep. They didn't know what was going on."

What happened to Ciolkowski at the American Therapeutic clinic was not an isolated instance. Federal prosecutors say it was a crime repeated over and over again with thousands of other patients as part of the nation's biggest case of mental healthcare fraud — costing the taxpayer-funded Medicare program hundreds of millions of dollars. The case has spurred criminal investigations into other mental health operators in South Florida, dubbed for years as the nation's capital of Medicare fraud.

In October, a Miami federal grand jury indicted American Therapeutic and four senior executives, accusing them of scheming to fleece $200 million from Medicare by billing for purported group counseling sessions to treat depression, schizophrenia or other mental illnesses that were either not necessary or not provided. All four officials, including the clinic chain's owner, Lawrence S. Duran, 48, have pleaded not guilty and are headed for trial in August.

Duran and two other executives were also accused of orchestrating an elaborate kickback operation involving American Therapeutic marketing employees, patient brokers, and operators of assisted-living facilities and halfway houses — which is how Ciolkowski got recruited.

This past week, the case expanded dramatically with the indictment of 20 American Therapeutic employees and others, including three physicians who prosecutors say approved patients for the majority of the company's phony claims and altered their diagnoses to qualify for Medicare payments.

Among the indicted doctors: Mark S. Willner, a Weston psychiatrist, who was paid $680,000 by American Therapeutic in exchange for approving therapy for patients implicated in $71 million worth of phony claims, prosecutors say. Willner himself billed Medicare for evaluating Ciolkowski's prescriptions, including the antipsychotic drug Seroquel for his purported bipolar disorder, the patient's records show.

American

American Therapeutic, a South Florida chain of seven clinics founded in 2000, ran its alleged scheme for years, tapping into a stream of mentally ill patients who were supposed to have received treatment in local hospitals before qualifying for outpatient group therapy sessions.

Article source: http://www.miamiherald.com/2011/02/26/2087342/medicare-racket-cashed-in-on-recruited.html

[Guest guest]

Medicare racket cashed in on recruited patients, feds say

February 27, 2011

Leon Ciolkowski has struggled with alcoholism for much of his life. But with that disease, the 63-year-old man was not going to qualify for costly group therapy sessions at American Therapeutic Corp.

So his Pompano Beach landord, who doubled as a patient broker for American Therapeutic, told him to pretend he suffered from a bipolar condition so he could get through the door.

American Therapeutic's clinic in Boca Raton gave him a false bipolar diagnosis, Ciolkowski said. And with his Medicare card, the company cashed in.

Altogether, the Miami-based business billed Medicare $9,110 to treat Ciolkowski for at least 29 group therapy sessions from February to April in 2009, his medical records show. They also show that the clinic regularly charged for two counseling services during each daily visit, which is not allowed under Medicare policy.

"There was no therapy," said Ciolkowski, recalling his experience at American Therapeutic. "Sometimes we would talk about our problems, but mostly we would just sit there for hours doing nothing.

"I'd see these other people urinating on themselves," he added. "Their food would be all over them. They'd just stare at the walls or sleep. They didn't know what was going on."

What happened to Ciolkowski at the American Therapeutic clinic was not an isolated instance. Federal prosecutors say it was a crime repeated over and over again with thousands of other patients as part of the nation's biggest case of mental healthcare fraud — costing the taxpayer-funded Medicare program hundreds of millions of dollars. The case has spurred criminal investigations into other mental health operators in South Florida, dubbed for years as the nation's capital of Medicare fraud.

In October, a Miami federal grand jury indicted American Therapeutic and four senior executives, accusing them of scheming to fleece $200 million from Medicare by billing for purported group counseling sessions to treat depression, schizophrenia or other mental illnesses that were either not necessary or not provided. All four officials, including the clinic chain's owner, Lawrence S. Duran, 48, have pleaded not guilty and are headed for trial in August.

Duran and two other executives were also accused of orchestrating an elaborate kickback operation involving American Therapeutic marketing employees, patient brokers, and operators of assisted-living facilities and halfway houses — which is how Ciolkowski got recruited.

This past week, the case expanded dramatically with the indictment of 20 American Therapeutic employees and others, including three physicians who prosecutors say approved patients for the majority of the company's phony claims and altered their diagnoses to qualify for Medicare payments.

Among the indicted doctors: Mark S. Willner, a Weston psychiatrist, who was paid $680,000 by American Therapeutic in exchange for approving therapy for patients implicated in $71 million worth of phony claims, prosecutors say. Willner himself billed Medicare for evaluating Ciolkowski's prescriptions, including the antipsychotic drug Seroquel for his purported bipolar disorder, the patient's records show.

American

American Therapeutic, a South Florida chain of seven clinics founded in 2000, ran its alleged scheme for years, tapping into a stream of mentally ill patients who were supposed to have received treatment in local hospitals before qualifying for outpatient group therapy sessions.

Article source: http://www.miamiherald.com/2011/02/26/2087342/medicare-racket-cashed-in-on-recruited.html