Health Care Network of Miami Medical Director & 3 Therapists Sentenced for Their Roles in $63 Million Health Care Fraud

from a Press Release.

Department of Justice

Office of Public Affairs

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FOR IMMEDIATE RELEASE

Friday, November 6, 2015

Medical Director and Three Therapists Sentenced for Their Roles in $63 Million Miami Health Care Fraud Scheme

A former medical director and three therapists from defunct health provider Health Care Solutions Network Inc. (HCSN) were sentenced today in Miami for their roles in a scheme to fraudulently bill Medicare and Florida Medicaid more than $63 million.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office and Special Agent in Charge Shimon Richmond of the U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG) Miami Regional Office made the announcement.

Roger Rousseau, 73, of Miami, the former medical director of HCSN in Florida, was sentenced by U.S. District Judge Robert N. Scola of the Southern District of Florida to 192 months in prison.  Therapist Liliana Marks, 49, of Homestead, Florida, was sentenced to 72 months in prison.  Therapists Doris Crabtree, 63, of Miami, Angela Salafia, 68, of Miami Beach, Florida, were each sentenced to 60 months in prison.  In addition to their terms of imprisonment, each defendant was sentenced to three years of supervised release.  Restitution will be determined at a hearing on Jan. 15, 2016.

On Aug. 24, 2015, following a two-week trial, the jury convicted all four defendants of conspiracy to commit health care fraud.  Rousseau was additionally convicted of two counts of health care fraud.  In total, 22 defendants have been charged and convicted for their roles in the HCSN scheme, including the former owner of HCSN, Armando “Manny” Gonzalez.

According to evidence presented at trial, HCSN purported to provide intensive mental health services to Medicare and Medicaid beneficiaries in Miami and Hendersonville, North Carolina, from approximately 2004 through 2011.  These services were not medically necessary and were often never even provided.  HCSN paid kickbacks to assisted living facility owners and operators in Miami who, in exchange, referred beneficiaries to HCSN.  In support of this scheme, Rousseau routinely signed what he knew to be fabricated and altered medical records.  Crabtree, Salafia and Marks fabricated HCSN medical records to support false and fraudulent claims for partial hospitalization program services that were not medically necessary and often never provided.  In total, HCSN submitted approximately $63.7 million in false and fraudulent claims to Medicare, and received payments totaling approximately $28 million on those claims.

This case was prosecuted by Trial Attorneys Allan J. Medina, Lisa H. Miller and Bryan D. Fields of the Criminal Division’s Fraud Section.  The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Southern District of Florida. 

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 2,300 defendants who have collectively billed the Medicare program for more than $7 billion.  In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to:www.stopmedicarefraud.gov.  

http://www.justice.gov/opa/pr/medical-director-and-three-therapists-sentenced-their-roles-63-million-miami-health-care