Miami jury convicts last two defendants in Medicare scam

Filed under DAYTONA BEACH, NEWS

BY JAY WEAVER
THE MIAMI HERALD (MCT)

MIAMI — The nation’s biggest mental health scam against Medicare — totaling $200 million in false billings — ended with a quick bang Monday when the last two defendants in a long-running probe were found guilty in Miami federal court.

The health care fraud convictions of Roger Bergman, 65, a physician’s assistant, and Rodolfo Santaya, 55, a patient recruiter, capped the Justice Department’s sprawling investigation that sent about 40 South Florida defendants to prison — including Lawrence Duran, the former co-owner of the Miami-based American Therapeutic Corp.

Prosecutor Nicholas Surmacz said the two defendants, convicted after less than three hours of jury deliberations, participated in a “massive conspiracy to rip off Medicare.”

U.S. District Judge Jose Martinez ordered that Bergman and Santaya, both of Miami-Dade County, be placed in custody at the Miami Federal Detention Center as they await what are likely to be lengthy prison terms.

50-year sentence
Federal agents raided American Therapeutic’s seven clinics from South Florida to Orlando in the fall of 2010, leading to Duran’s guilty plea that sent him to prison for 50 years — the longest sentence ever for a Medicare fraud offender.

Duran and his girlfriend, Marinella Valera, the co-owner and therapist sentenced to 35 years, lived in a Miami bay-front condo and tooled around in a Maserati when their business was shuttered after pocketing $87 million in Medicare proceeds.

On Monday, Justice Department lawyers said that Bergman and Santaya carried out the chain’s fraudulent activity at a Homestead clinic, where patients suffering from dementia, Alzheimer’s and other ailments were exploited solely for swindling the taxpayer-funded Medicare program.

Prosecutors said hundreds of patients were in such bad condition that they could not have benefited from any group psychotherapy sessions at American Therapeutic.

“They didn’t even know what country they were in … they were using trash cans as restrooms,” Surmacz said in closing arguments to the 12-person jury, which convicted the two defendants on conspiracy, fraud and other counts.

Bogus tests
The prosecutor said that Bergman conducted bogus evaluations of hundreds of patients and falsified their records to dupe Medicare into believing they needed the costly mental health services.

Surmacz said the certified physician’s assistant processed the patients for a psychiatrist, Dr. Alberto Ayala, now convicted, who was sometimes out of the country despite records purportedly showing he was at the Homestead clinic seeing patients. Bergman was paid $90,000 a year before leaving American Therapeutic in 2008.

The prosecutor said Santaya, the recruiter, delivered a stream of patients to the Homestead clinic, which generated $2.9 million in fraudulent Medicare billing activity. Santaya not only received kickbacks from American Therapeutic’s marketing director and others, but he also used some of that money to pay patients with valuable Medicare cards between 2006 and 2009.

Paid to lie
Santaya was found guilty of accepting a pair of kickbacks — $9,495 and $8,250 — but the prosecutor said that represented only a snapshot of the recruiter’s cash payments from American Therapeutic.

Agents with the FBI and Health and Human Services also discovered that Santaya, a certified nursing assistant, deposited about $50,000 in his bank account in 2009 alone.

Surmacz, the prosecutor, said that Santaya paid his patients to lie about suffering from mental health problems and to keep silent. “(He) trained his patients about what they needed to say to fake their mental health problems,” Surmacz said.

‘Horrible, horrible fraud’
Defense attorneys for the physician’s assistant and patient recruiter tried to portray their clients as “outsiders” who knew nothing about American Therapeutic’s fraudulent scheme that spanned most of the past decade.

“There is no question that this was a horrible, horrible fraud,” Bergman’s attorney, Terence Lenamon, told jurors during closing arguments. “But the government of the United States wants you to believe it was absolute.”

Lenamon, whose client testified, said he was just doing his job. “He was an outsider. He was never part of the group,” the attorney argued. “He never fit in. He never did anything illegal.”

Santaya’s lawyer, Emmanuel Perez, said his client “never conspired with Mr. Bergman or anyone else to commit Medicare fraud.”

To make their case, Justice Department lawyers deployed fraudulent billing records, patient ledgers, bank accounts, corporate emails and key cooperating witnesses.

Among them: American Therapeutic’s former co-owner, Valera, and the company’s one-time marketing director, Margarita Acevedo, who was in charge of doling out millions of dollars to patient recruiters and Medicare beneficiaries.

Robert Zink, a Justice Department lawyer, countered that the two defendants, Bergman and Santaya, may have claimed “they were not part of the fraud, stink and stench of American Therapeutic. But they were.”

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