Healthcare providers continue to receive lengthy sentences from federal district court judges in the Sothern District of Florida in the wake of the Health Care Solutions Network Inc. (HCSN) community mental health center fraud. From 2004 to 2011, HCSN billed Medicare and the Florida Medicaid program approximately $63 million for purported mental health services. Fifteen individuals have been charged for their roles in the fraud at HCSN and twelve have pleaded guilty, including HCSN’s owner who was sentenced in February 2013 to 168 months in federal prison.

According to court documents, HCSN paid illegal kickbacks to owners and operators of assisted living facilities for patient referral information to be used to submit false and fraudulent claims to Medicare and Medicaid. Because many of these referral patients suffered from mental retardation, dementia and Alzheimer’s disease, they were ineligible for Partial Hospitalization Program services. HCSN personnel fabricated therapy notes and other medical records to make it appear that legitimate and reimbursable services were provided to these patients in order to receive payment from the government. In many instances, these records were created weeks or months after patients were admitted to HCSN in an effort to justify the improper claims. ¬†According to the government, instead of receiving the therapy that was billed, patients often watched Disney movies, played bingo and had barbeques. Therapists at HCSN were directed to remove from medical records references to these recreational activities to avoid detection and facilitate payment of the false claims.

The latest sentences to arise from this case are as follows:

  • After pleading guilty in March to conspiracy to commit healthcare fraud, a former therapist and clinical director of HCSN was sentenced last week to 111 months in federal prison. During the course of the conspiracy, the therapist worked full time at multiple HCSN locations in Florida, serving in various capacities including, substance abuse counselor and therapist as well as clinical director of HCSN’s Partial Hospitalization Program.
  • Another therapist and program coordinator of HCSN’s Partial Hospitalization Program received a sentence of 70 months in federal prison for routinely fabricating medical records for purported mental health treatment for patients that were ineligible for the services billed. Additionally, that therapist admitted that when she was an unlicensed clinical social worker intern, she provided unlicensed therapy while licensed therapists were not present.

Additionally, in April 2013, an HCSN supervisor was convicted of conspiracy to commit healthcare fraud by a jury sitting in the Southern District of Florida after a five-day trial. Shortly thereafter, in early May, another HCSN therapist and clinical director pleaded guilty to one count of healthcare fraud and one substantive count of healthcare fraud. The sentencing of those individuals are scheduled to occur soon.