Industry News

Former Mental-Health Clinic Therapist Sentenced to 120 Months in Prison for Role in $55 Million Medicare Fraud Scheme.

Jennifer Kirchner | November 2013

A former therapist for Biscayne Milieu, a Florida mental-health clinic, was sentenced to prison for 120 months due to his role in a $55 million Medicare fraud scheme.  Biscayne Milieu purported to run a partial hospitalization program (PHP) for intensive treatment of severe mental illness.  The defendants, including the therapist, clinic owners, doctors, managers and other clinic employees, devised a scheme to pay kickbacks to patient recruiters to refer ineligible Medicare beneficiaries to Biscayne Milieu for services that were not performed or reimbursable under Medicare.  Evidence at trial showed that the therapist, Jose Rojo, knowingly conducted sham therapy sessions for patients ineligible for PHP services, including chronic substances abusers, sufferers of extreme dementia who would not benefit from group therapy, and individuals with no mental health diagnosis that were seeking exemptions for their U.S. citizenship applications.  Evidence at trial further showed that Rojo created fraudulent documents, including false treatment plans and group therapy notes to conceal the clinic’s fraudulent activities.  Rojo also sold his falsified group therapy notes to other therapists at the clinic.

More than 25 defendants have plead guilty or have been convicted in relation to the fraud scheme.  Biscayne Milieu’s owners received prison sentences ranging from 22 to 30 years.  Additionally, the clinic and its owners were ordered to collectively pay more than $11 million in restitution.

The Department of Justice news release is available at:

Department of Justice. “Former Mental-Health Clinic Therapist Sentenced for Role in $55 Million Medicare Fraud Scheme.” Justice News. 6 Nov. 2013.

About the Author

Jennifer Kirchner is a licensed attorney in Illinois and Wisconsin. Ms. Kirchner has expertise in assessing provider compliance with the Anti-Kickback Statute, Stark Law, the False Claims Act, HIPAA Privacy and Security Rules and clinical research laws and regulations.