Miami-Area Psychiatrist Pleads Guilty for Role in $200 Million Medicare Fraud Scheme

Miami-Area Psychiatrist Pleads Guilty for Role in $200 Million Medicare Fraud Scheme

WASHINGTON - A Miami-area psychiatrist pleaded guilty today in U.S. District Court in Miami for his part in a fraud scheme that resulted in the submission of more than $200 million in fraudulent claims to Medicare, the Department of Justice, FBI and 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.   Gumer was charged on Feb. 15, 2011, with one count of conspiracy to commit health care fraud and four counts of health care fraud.

According to court documents, Gumer was a psychiatrist at American Therapeutic Corporation (ATC), a Florida corporation headquartered in Miami.   ATC purported to operate partial hospitalization programs (PHPs) in seven different locations throughout South Florida and Orlando.  A PHP is a form of intensive treatment for severe mental illness.

Gumer admitted that he signed evaluations, notes and other documents in medical files for patients who did not need the treatment for which ATC billed Medicare.   Specifically, as a psychiatrist, Gumer knew that the patients attending ATC did not need intensive mental health treatment, and that the treatments offered by ATC were not the type of intensive treatments a PHP should provide.   Gumer admitted that he signed these files without examining the patients, or writing and reading the statements he was signing.   Gumer also admitted to writing prescriptions for psychiatric medications for patients who did not need them in order to make it appear to Medicare that the patients qualified for PHP treatment.   According to court documents, Gumer also referred hundreds of ATC patients to a related company, the American Sleep Institute (ASI), for unnecessary diagnostic sleep disorder testing.

According to court filings, Gumer’s co-defendants and ATC’s owners and operators paid kickbacks to owners and operators of assisted living facilities (ALFs) and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and ASI.  In some cases, the patients received a portion of those kickbacks.  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 PHP programs so that ATC and ASI could bill Medicare for more than $200 million in medically unnecessary services.

According to the plea agreement, Gumer’s participation in the fraud resulted in $19.3 million in fraudulent billing to the Medicare program.   Sentencing for Gumer is scheduled for Jan 19, 2012.  Gumer faces a maximum of 10 years in prison and a $250,000 fine. 

ATC, its management company Medlink Professional Management Group Inc., and the owners and lead manager of ATC, Medlink and ASI, were charged with various health care fraud, money laundering and other offenses in a separate superseding indictment unsealed on Feb. 15, 2011.   Two of the three owners and the lead manager, as well as both ATC and Medlink, have pleaded guilty and have admitted to the fraudulent scheme and that more than $200 million in billings were submitted to the Medicare program as a part of the scheme.   They are scheduled for sentencing on Sept. 14, 2011, by U.S. District Court Judge James Lawrence King.   The trial of the third owner charged in the separate superseding indictment is scheduled to begin on Aug. 15, 2011.  

The remaining 17 co-defendants named in the indictment in which Gumer was charged are scheduled to stand trial on Nov. 7, 2011, before U.S. District Judge Patricia A. Seitz.

An indictment is merely an accusation and defendants are presumed innocent unless and until proven guilty in a court of law.

         

Today’s guilty plea was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; John V. Gillies, Special Agent-in-Charge of the FBI’s Miami field office; and Special Agent-in-Charge Christopher Dennis of the HHS Office of Inspector General (HHS-OIG), Office of Investigations Miami office. 

         

The criminal case is being prosecuted by Trial Attorney Jennifer L. Saulino of the Criminal Division’s Fraud Section.  The case was investigated by the FBI and HHS-OIG and 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 operations in nine locations have charged more than 1,000 defendants that collectively have billed the Medicare program for more than $2.3 billion.  In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG are taking steps to increase accountability and decrease the presence of fraudulent providers.

How Not To Hide A Secret Love Child - Baby LK Report For May 29th 2011

Baby LK recaps the week in news for the child protection industry.

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SCOTUS Continues To Strips Whistleblowers of Whistles

The relator approaches the court, on behalf of the United States, on a mission, fearful of those horrible tales of loosing every chance of hope of being made whole again.  Out of the darkness of the legal forest, lurking, are the public disclosure bars of "persons, administrative, reports". Oh my.

At any time, the Court will crush you using one of these "interpretive buttresses" snatched off the Magna Carta, to beat you down and make you and your children go back to the fields and pick tomatoes and lettuce.  (Well, that is the goal once all the anchor babies are cleaned out of the country to give these great jobs to hard working, cheaper laboring American children.)

First the Supreme Court of the United States (SCOTUS) says, "Even though all the other laws say a State is a person, we don't think so when it comes to States allowing federal programs to be ripped off under the False Claims Act because it would be too embarrassing for the us because we allowed the States to do whatever they wanted when we give them money, and besides, the States never had to be held to fraud standards before in federal contracts and the Congress was never clear in its intent for the States to be considered as 'persons'."

How dare some average person dare think they have the entitlement right to challenge us!  We are the great Supreme Court of the United States!  Poor people have no rights and definitely no right to sue and get rich.

SCOTUS False Claims Act Opinion of Justice Scalia

There was a lone dissent which believed States were intended by the Congress to be considered as "persons".
SCOTUS Stevens False Claims Act Dissent in Vermont Agency of Natural Resources v. U.S. ex rel. Stevensre

Then came another shaving of the qui tam when SCOTUS decided anything "administrative" fell under the "public disclosure bar" meaning any state or federal report, hearing, audit, or anything else as such are not allowed to be used by an original source.
Supreme Court of the United States GRAHAM COUNTY SOIL AND WATER CONSERVATION DISTRICT et al., Petitioners...

But wait, SCOTUS, as well as those whose corporations make substantial killings, literally, bilking Medicaid in child welfare, decided that anything requested through a Freedom of Information of Act request falls under the "public disclosure bar".

Let's pretend this actually happened:

I walk into the residential institution where my child incarcerated after being ripped from his bed in the middle of the night for no reason beyond child protective services and the police going to the wrong address, is being tortured and, with a fake smile I politely ask for his IEP.  They hand it to me and it states he is considered "ineligible" for special needs, institutionalization and does not need medication, yet he is locked up in solitary confinement, beaten, raped, tortured, drugged suffering multiple heart attacks, tardive dyskensia, attempted suicides, surviving from meals of dried bread and potatoes with no heat in the winter or air conditioning in the summer, with different dates of birth on the court reports submitted to the court because my child was under aged for the facility.

Then, I go the office of the clerk of the court and pull his child protective services case and find out they fabricated a story of a car crash that never took place and had a duplicate fake case as a juvenile delinquent and were not just double billing, but billing me as a juvenile delinquent, also.

So I go and file a FCA and the court says: "So sorry, those are public docs and therefore, the States can do whatever the fuck they want to do and there is nothing that will ever be done because we only cater to the rich."

Let's keep pretending this did not happen, either.
Supreme Court of the United States SCHINDLER ELEVATOR CORPORATION, Petitioner, v. UNITED STATES ex rel. Dan...

"Qui tam pro domino rege quam pro se ipso in hac parte sequitur!"

Being a whistleblower and reporting fraud is a right of free speech.  Verifying it through FOIA requests makes an original source the subject matter expert.  I dare anyone to challenge, publicly of course, my expertise in child welfare fraud, even SCOTUS.

Conyers, Paul Introduce Quality Health Care Coalition Act

Conyers, Paul Introduce Quality Health Care Coalition Act
Leveling the Playing Field Between Insurance Companies and Health Care Providers
(Washington)—Today, House Judiciary Committee Ranking Member John Conyers, Jr. (D-Mich.) and Congressman Ron Paul (R-Texas) introduced the “Quality Health Care Coalition Act of 2011,” H.R. 1409, in an effort to improve the quality of patient care by leveling the playing field between health care professionals and insurance companies in the health care industry. 

“Currently, the insurance industry, including health care insurance providers, is immune from federal antitrust laws under the McCarran-Ferguson Act,” said Conyers.  “As a result, the playing field is woefully unbalanced.  I am pleased to introduce H.R. 1409 the Quality Health Care Coalition Act of 2011 today to strengthen patient safety and quality of care by clarifying the application of the antitrust laws to negotiations between groups of health care professionals and health plans and health care insurance issuers.  I am gratified to be joined by my good friend Rep. Paul in this effort.” 

“By restoring the freedom of medical professionals to voluntarily come together to negotiate as a group with HMOs and insurance companies, this bill removes a government-imposed barrier to a true free market in health care,” said Paul.  “ I thank Mr. Conyers’ for introducing this bill, and I hope all members of Congress will support the Quality Health Care Coalition Act” and restore freedom of contract and association to America's health care professionals.”

The bipartisan Quality Health Care Coalition Act of 2011 will allow health care providers the ability to collectively bargain contractual terms with insurers, including provisions that affect the quality of patient care.  Last Congress, the House Judiciary Committee held a hearing on the disparate treatment of physicians and health insurers by the antitrust enforcement agencies.  In 2000, the House passed similar legislation, H.R. 1304, the Quality Healthcare Coalition Act of 1999) offered by Rep. Tom Campbell (R-CA) and Rep. Conyers.  The bill passed the House by a vote of 276-136, but was not taken up  the Senate.  Similar legislation was introduced in the 107th (H.R. 3897) and 108th (H.R. 1120) Congresses.

Michigan Did Not Get Its False Claims Act Together, Again

Pay attention to the whom the review was addressed.  Mike Cox is no longer Attorney General.  It is now Bill Schuette. 


HHS OIG Review of Michigan False Claims Act 2011

Conyers: One Year Later, Affordable Care Act’s Positive Impact Has Already Been Felt by America

Wednesday, March 23, 2011

Conyers:  One Year Later, Affordable Care Act’s Positive Impact Has Already Been Felt by America

Conyers Celebrates the One Year Anniversary of the Affordable Care Act by Praising the Term, “Obamacare”

(Washington)—Congressman John Conyers, Jr. (MI-14)  issued the following statement today celebrating the first anniversary of the comprehensive health care reform law, the Affordable Care Act, that passed last Congress and was signed into law by President Obama on March 23, 2010.

“Not withstanding the unfounded views of the President's political opponents, there is no denying that the Affordable Care Act has already significantly helped the people of Michigan and the rest of the country,” said Conyers.  “Michigan residents will no longer have to worry about their children losing coverage because of a pre-existing condition or a mistake made on an application, and I have yet to meet one parent who would not want their children to stay on their insurance plan until the age of 26.”  

“Contrary to many people’s intentions to use the term, ‘Obamacare’ to derogate the health care reform law, I believe the name does the opposite in praising President Obama for leading the Nation to make the first step towards achieving the goal of affordable health care for all,” said Conyers.  “Who wouldn’t want to get credit for legislation that will reduce the deficit, create more jobs, and ensure access to quality health care?”

Specifically, the Affordable Care Act is already helping the people of Michigan by:

·         Providing New Benefits and Lowering Costs for Medicare Beneficiaries

·         Lowering Taxes for Small Businesses

·         Providing Greater Resources for Michigan

·         Providing New Coverage Options for Young Adults

·         Covering Children with Pre-Existing Conditions

·         Removing Lifetime Limits on Health Benefits

·         Making it Illegal for an Insurance Company to Drop Coverage When You Get Sick

·         Creating New Coverage Options for Individuals with Pre-Existing Conditions

·         Increasing Support for Community Health Centers

#3-23-2011#

REINS Is Literally "Job-Killing"

Oh, this is hilarious.

Here you have a group of individuals who believe regulation is "job killing".  Well, when you are dealing with elected persons who lack administrative sophistication, you must assume their advice comes from their advocates... oops, I mean lobbyists, the same individuals who would significantly benefit from less regulatory mandates.

See, it goes like this, even though all three branches of government have their input into any administrative regulation that comes down, it is actually "job killing" because most of the local governments would not be in operation if they had to be compliant, let alone have to be compliant wtih civil rights policies.  This rings with even more truth when you understand that these "economically significant" new rules that may come down are dealing with privatization, out-sourced by state governments.

If one possessed basic understanding of the legislative process, one would know there currently exists multiple forms of input from the people regarding the formation and adoption of regulations beyond the sole elected official.


There is the Federal Registry which allows for public content.  The elected official who is concerned with having a voice should assist and engage his/her constituents in the opportunities to submit historical comments into federal record.

Then, there is always the role of the elected official to, again, assist and engage his/her constituents on how to contact the administrators of each agency to voice concerns and to provide critical input in the development of any policies.

Alas, it seems here the elected official would prefer to bog down the legislative process in minutia of applying a fifth layer of approval for policies which would virtually shut down governmental functions.  Grandstanding at its finest.

Now, let's examine the counterfactual of a "so-called" removal of regulatory policies.  Let's take EPA for example.

You remove regulation of EPA, people become sick and die.  Sick people tend to cause a soaring costs to overall health care.  Sick people can not work nor be productive to society which means that they will not be able to afford individual private insurance and seek the single payer programs.  The moral hazard kicks in to increase the cost of private insurance placing more individuals at risk of loosing their medical coverage.

As the insurance companies financially benefit with an increase in profits by cherry picking who will be insured, there will be a need to further reduce its work force with fewer clients.
Dead people do not work nor pay taxes.

Now, that is what I call "job-killing", literally.

Beverly Tran
An Original Source

Michigan Senate Resolution To Memorialize Congress For Moritoria On Regulation With REINS Act 2011