Two providers receive prison time, fines for Medicare/Medicaid fraud

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Two women are the latest healthcare providers to be convicted for defrauding the government in recent judgments.

Jacqueline Wheeler, who operated a pair of healthcare companies in the District of Columbia, received the more severe penalties. A jury found the CEO and co-owner of Health Advocacy Center Inc. (HACI) and owner of Sheridan Rehabilitative and Wellness Centers guilty of one count of healthcare fraud and 34 counts of making false statements relating to healthcare matters.

Wheeler, of Chevy Chase, MD, filed more than $7 million in fake Medicaid claims, according to Ronald C. Machen Jr., the U.S. Attorney for the District of Columbia. Prosecutors said Wheeler listed herself as a medical doctor but was actually a non-board-certified naturopath. Through HACI, she personally submitted at least 600 false claims for manual therapy care provided to 22 patients from 2006 to 2008.

Prosecutors charged that Wheeler filed claims that showed the center provided from 20 to 48.5 continuous hours of manual therapy for each patient in 24-hour periods.

Wheeler filed $7.7 million in fraudulent claims and received $3.17 million, officials said.

Judge Ellen S. Huvelle, of the U.S. District Court for the District of Columbia, sentenced Wheeler to six years, three months in prison and $6.34 million in fines and restitution. Wheeler also received three years' probation and was banned from the healthcare industry.

Meanwhile, Alba Serrano, the owner of a Florida assisted living facility, received 15 months in prison for sending patients to fraudulent mental health providers for kickbacks.

Judge Patricia A. Seitz, of the U.S. District Court for the Southern District of Florida, also sentenced the Miami resident to three years of supervised release and $258,329 in restitution.

The sentence followed a June guilty plea. A U.S. attorney's office press release said Serrano funneled assisted living facility (ALF) patients to fraudulent mental health providers American Therapeutic Corp. (ATC) and Health Care Solutions Network (HCSN).

The Serrano sentence was the latest in the fallout from ATC's scheme.

Prosecutors said Serrano operated the ALF Elsa's House in South Miami for more than two decades. She pleaded guilty to sending Medicare beneficiaries at Elsa's House to American Therapeutic Corp. (ATC) and Health Care Solutions Network (HCSN) for partial hospitalization program (PHP) services to receive illegal health care kickbacks.

Prosecutors added that ATC, its management company, Medlink Professional Management Group Inc., and various owners, managers, doctors, therapists, patient brokers, and marketers of ATC, were charged with various offenses in two indictments unsealed in February 2011. Medlink and more than 20 of the individual defendants charged in these cases have pleaded guilty or have been convicted at trial, according to the U.S. attorney's office.