Two Miami Residents Indicted in Ongoing Medicare Fraud Investigation

Many articles that have been posted here deal with the offense of Medicare Fraud. On October 4 of last year one of the articles posted was a story of a federal probe that spotlighted South Florida clinics dealing with Home Health care criminal abuses where the total of fraudulent Medicare billing exceeded $74 million dollars. Earlier this year another story was posted dealing with the publically owned WellCare health company that paid restitution of more than $100 Million to settle lawsuits that had alleged abuses of the False Claims Act. Although the company still operates and trades on the New York Stock Exchange (NYSE: WCG), a new board of directors has been put in place.

The dollar amounts are staggering and the frauds continue, and regrettably, South Florida leads the nation in these categories of criminal activities.

Last week, yet again, another indictment was unsealed and announced by numerous federal authorities including Special Agent in Charge Christopher B. Dennis of the Health and Human Services Office of the Inspector General’s Office of Investigations, Miami Office. It identified two more residents of Dade County that were charged with receiving health care kickbacks, and conspiracy to defraud the United States government. They were both originally accused in a continuing investigation of a $190 million Medicare fraud.

Jose Martin Olivares, 36, and Mayelin Santoyo, 28, were both charged for their participation in the scheme. Both appeared in the indictment with one count each on the conspiracy charge and two counts each of the actual acceptance of payoffs. If convicted, they both face a maximum penalty of five years of incarceration for each of the individual counts against them.

The two were in the service of American Therapeutic Corporation (ATC) and its management company, Medlink Professional Management Group Inc. (Medlink) which perpetrated the fraud. The company was based in Miami and has been non-operational since 2011 when its owners, patient brokers, managers and doctors, as well as other individuals employed by them all pleaded guilty, or were convicted at a trial that took place in 2011. The owner of ATC was sentenced to 50 years in prison for his role in organizing and implementing the structure of the scheme to defraud Medicare.

Authorities investigating the case say that both Olivares and Santoyo acted as patient brokers for ATC which operated seven Florida mental health clinics during the time frame of Feb. 2006 through Oct. 2010.

It is alleged in the indictment that Olivares and Santoyo in their capacity delivered patients that were actually ineligible for services from the Company and then received kickbacks of cash and/or checks as their compensation. The total amount of money received by the recruiters was determined by the amount of actual days each of the conscripted individuals was under the so-called care of the ATC. It has already been ascertained that during the course of the scheme, millions of dollars in kickbacks were paid in exchange for the presentation of Medicare beneficiaries who did not qualify for PHP services. PHP services are a Partial Hospitalization Program which is a type of concentrated treatment for severe mental illness. These recruited patients took part in treatment programs that were not authentic PHPs. This allowed ATC to bill Medicare for what were actually medically unneeded services. To acquire the cash essential to support the kickbacks, the now convicted persons involved in the fraud laundered millions of dollars of outflows from Medicare, according to court documents.

The case has, and is still is being investigated by the FBI and HHS-OIG, and was under the authority of the Medicare Fraud Strike Force (MFSF).

From the time of its commencement in March 2007, the MFSF have charged in excess of 1,500 offenders who have falsely billed Medicare for more than $5 billion in false claims. The MFSF operates in nine separate locations throughout the United States. To report Medicare Fraud, visit the Web site www.medicarefraudcenter.org

To read our previous articles mentioned above, click the below links:
Medicare Fraud; Federal probe spotlights South Florida clinics
WellCare Health Care Fraud Trial Delivers Mixed Verdicts


The consequences of a conviction for Medicare Fraud can be extremely punitive and can often include lengthy prison terms, monetary penalties and restitution of funds acquired through the fraud. It is imperative that if an individual is charged with Medicare fraud, conspiracy to commit Medicare fraud, or any other related charge to immediately contact an experienced attorney, who practices in the in the tri-county area (Dade, Broward & Palm Beach counties), and has experience in the field of Medicare Fraud to properly handle the case.

If you, a friend or family member is facing allegations of Medicare Fraud or any federal offense, it is essential that a knowledgeable criminal attorney with a strong understanding of federal law is retained.

Mr. Cohen is a board certified criminal trial lawyer rated AV by Martindale Hubbel (pre-eminent) and a “Super Lawyer” recognized as being in the top 5% of his specialized field (criminal trial law) among Florida lawyers. He is considered a specialist by the Florida Bar in his field. Mr. Cohen has tried scores of cases over his 35 year career and is a member of the Florida and New York Bars. He practices in Fort Lauderdale, West Palm Beach and Miami, among other counties. He is also admitted to practice in the United States Court of Appeals for the Eleventh and Second Circuit.

Mr. Cohen’s practice has recently expanded and he is now a partner in the prestigious law firm of McLaughlin & Stern, LLP. Through this partnership, Mr. Cohen can now lead your defense in the New York Metropolitan area in addition to the Broward, Dade, or Palm Beach County areas as well as all other jurisdictions throughout the state of Florida
Mr. Cohen is also listed in the 2013 edition of “Best Lawyers in America