A Florida psychiatrist pleaded guilty last week for his role in a health care scam that resulted in the submission of more than $200 million worth of bogus claims to Medicare, the Department of Justice, the FBI and the Department of Health and Human Services (HHS) announced.
Dr. Alan Gumer, 64, of Tamarac, Fla., pleaded guilty to one count of conspiracy to commit health care fraud after being charged on Feb. 15, 2011, along with 19 others involved in the scheme, on various counts of health care fraud, money laundering and other offenses.
Gumer was a psychiatrist at American Therapeutic Corporation (ATC), a Miami-based corporation that supposedly operated partial hospitalization programs (PHPs) in seven locations throughout South Florida and Orlando. Co-defendants included ATC; its management company, Medlink Professional Management Group Inc.; and the owners and lead manager of ATC, Medlink and the American Sleep Institute (ASI).PHPs administer intensive treatment to patients suffering from severe mental illness, and Gumer admitted signing evaluations, notes and other medical documents for patients he knew didn't need the intensive -- and expensive -- treatment for which ATC billed Medicare.
Gumer admitted signing papers without examining the patients or even writing and reading the statements he was signing. He also confessed to writing prescriptions for unnecessary psychiatric medications in order to fool Medicare into believing the patients qualified for PHP treatment.
The crooked doctor also referred hundreds of ATC patients to a related company and co-conspirator, ASI, for pointless diagnostic sleep disorder testing. Gumer's co-defendants, ATC's owners and operators, paid kickbacks to owners and operators of assisted living facilities (ALFs), halfway houses and patient brokers in exchange for ineligible patients which ATC and ASI could use to defraud Medicare. "Patients" sometimes received a cut of the kickbacks as well.
Overall, the ATC and ASI paid out millions of dollars in kickbacks in exchange for bogus Medicare beneficiaries who didn't qualify for PHP services to attend illegitimate treatment programs so ATC and ASI could swindle Medicare for more than $200 million in unnecessary medically services.
Gumer's role in the scheme was responsible for $19.3 million in fraudulent Medicare billing alone, and he faces a maximum of 10 years in prison and a $250,000 fine. Gumer's sentencing is scheduled for January 2012.
ATC, its owners, and the lead manager of ATC, Medlink and ASI were charged with various counts of health care fraud, money laundering and other offenses in a separate superseding indictment unsealed on Feb. 15, 2011.
Two of the three ATC owners and the lead manager, as well as both ATC and Medlink, have pleaded guilty to more than $200 million in fraudulent Medicare billing and are scheduled for sentencing in September 2011. The trial of the third owner charged is scheduled to begin in August of this year. The remaining 17 co-defendants named in the indictment in which Gumer was charged are scheduled to stand trial in November 2011.
The case 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 has charged more than 1,000 defendants who fraudulently billed Medicare for more than $2.3 billion.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.
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