Woman pleads guilty in $200M Medicare fraud

Michael P. Tremoglie Jan. 18, 2012, 10:35am

MIAMI (Legal Newsline) - A Miami woman has pleaded guilty to her role in making more than $200 million in fraudulent Medicare claims.

The Department of Justice's Medicare Strike Force said Sandra Jimenez, 38, pleaded guilty Tuesday in U.S. District Court in Miami for her role in the submissions. Jimenez pleaded guilty 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.

The fraud scheme was orchestrated by the owners and operators of American Therapeutic Corporation; its management company, Medlink Professional Management Group Inc.; and the American Sleep Institute. All were Florida corporations headquartered in Miami.

ATC operated purported partial hospitalization programs -- a form of intensive treatment for severe mental illness -- in seven different locations throughout South Florida and Orlando. ASI purported to provide diagnostic sleep disorder testing.

ATC's owners and operators paid kickbacks to owners and operators of assisted living facilities, halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and ASI. The patients received a portion of those kickbacks in some instances.

Throughout the course of the ATC and ASI conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries, who did not qualify for PHP services, to attend treatment programs that were not legitimate PHPs. ATC and ASI then billed Medicare for the medically unnecessary services.

Jimenez admitted that she solicited beneficiaries and paid kickbacks to assisted living facility owners in exchange for the beneficiaries. The amount of the kickback was based on the number of days each patient spent at ATC.

She also admitted participating in a separate Medicare fraud scheme through Priority Home Health, a Miami home health agency that submitted fraudulent claims to Medicare for home health services. Jimenez and her co-conspirators recruited Medicare beneficiaries to Priority Home Health who did not qualify for home health services.

According to the plea agreement, Jimenez's participation in the ATC fraud and the Priority Home Health fraud resulted in $46 million in fraudulent billings to the Medicare program. Sentencing is scheduled for 8:30 a.m. on June 27. Jimenez faces a maximum penalty of 15 years in prison and a $250,000 fine.

ATC and Medlink -- as well as 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 Feb. 15.

ATC, Medlink and nine of the individual defendants have pleaded guilty or have been convicted at trial. Other defendants are scheduled for trial on April 9.

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