MIAMI
A federal jury convicted a medical director and three therapists who worked at the now-closed Health Care Solutions Network Inc. of fraudulently billing Medicare and Medicaid of more than $63 million, federal officials announced today.
The false billing took place from 2004 to 2011, officials said.
Medicare and Medicaid paid approximately $28 million on those claims, authorities said.
Roger Rousseau, 73, of Miami; Doris Crabtree, 62, of Miami; Angela Salafia, 68, of Miami Beach, Florida; and Liliana Marks, 48, of Homestead, Florida, were found guilty Monday of conspiracy to commit health care fraud.
In addition, Rousseau was convicted of two counts of health care fraud. Sentencing is scheduled for Nov. 6, 2015, before U.S. District Judge Robert N. Scola Jr.
Rousseau was the former medical director of Health Care Solutions allegedly provided intensive treatment for mental illness. Crabtree, Salafia and Marks were therapists who worked for Health Care Solutions, officials said.
According to the evidence presented at trial, this is what happened:
- Health Care Solutions billed Medicare and Medicaid for mental health services that were not medically necessary or never provided.
- Health Care Solutions paid kickbacks to assisted living facility owners and operators in Miami who, in exchange, referred beneficiaries to Health Care Solutions.
- Rousseau routinely signed what he knew to be fabricated and altered medical records without reviewing the substance of the records and, in most instances, without ever meeting with the patients.
- Crabtree, Salafia and Marks fabricated medical records to support Health Care Solutions’ false and fraudulent claims for reimbursement for PHP services.
- In total, the health care provider submitted approximately $63.7 million in false and fraudulent claims to Medicare and Medicaid.
In November 2014, following a jury trial, co-defendants Blanca Ruiz and Alina Fonts were convicted of conspiracy to commit health care fraud, and Fonts also was convicted of health care fraud.
In February 2015, both Ruiz and Fonts were sentenced to serve six years in prison.