Tuesday, September 3, 2013

$63 Million Medicare Fraud Sentenced to Former Office Manager for Health Care Solutions Network

To serve 68 months in prison for her role in a fraud scheme that resulted in more than $63 million in fraudulent claims to Medicare and Florida Medicaid, A former office manager at the defunct health care provider Health Care Solutions Network Inc. (HCSN) was sentenced today in Miami.

Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Special Agent in Charge Michael B. Steinbach of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Office of Investigations, Miami office, made the announcement.

Forty five year old Lisset Palmero of Miami was sentenced by U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida.  Palmero was also added prison term of three years of supervised release and ordered to pay restitution in the amount of $17.4 million.

Palmero was employed as a receptionist and office manager at HCSN of a mental health facility that purported to provide Partial Hospitalization Program (PHP) services during the course of the conspiracy.  A PHP is a form of intensive treatment for severe mental illness.

HCSN of Florida (HCSN-FL) operated community mental health centers at two locations.  According to court documents, Palmero was aware that HCSN-FL paid illegal kickbacks to owners and operators of Miami-Dade County Assisted Living Facilities (ALF) in exchange for patient referral information to be used to submit false and fraudulent claims to Medicare and Medicaid. Palmero also knew that many of the ALF referral patients were ineligible for PHP services because they suffered from mental retardation, dementia, or Alzheimer’s disease.

Court documents expose that Palmero was aware that HCSN-FL personnel were fabricating patient medical records.  Many of these medical records were formed weeks or months after the patients were admitted to HCSN-FL for purported PHP treatment. Palmero was also aware that medical records were fabricated for “ghost patients” who were never admitted to the HCSN-FL PHP. During her employment at HCSN-FL, Palmero actively concealed the production of medical records by preparing, and causing others to prepare, documentation that was later used to support false and fraudulent billing to government-sponsored health care benefit programs, counting the Medicare and Florida Medicaid.

According to court documents, from 2004 through 2011, HCSN billed Medicare and the Florida Medicaid program approximately $63 million for purported HCSN-FL mental health services.

The FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, under supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida are investigating this case.  Trial Attorney Allan J. Medina and former Special Trial Attorney William J. Parente prosecuted the case.

The Medicare Fraud Strike Force is now working in nine cities in the country, have charged more than 1,500 defendants who have collectively billed the Medicare program for more than $5 billion since its inception in March 2007.  And also, HHS’s Centers for Medicare & Medic aid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.