The Associated Press
May 7, 1999
Six employees of mental health clinic charged with Medicaid fraud
Dateline: Miami
Six employees of an outpatient mental health clinic were charged with engaging in an organized scheme to defraud the state out of Medicaid funds.
The Florida Attorney General’s Medicaid Fraud Control Unit arrested two owners, an office manager, two counselors and a psychiatrist of the Prometeo Counseling Center, which remained closed Thursday, after an undercover investigation exposed the alleged scheme.
An undercover agent, posing as a patient, attended group therapy sessions, which consisted of drinking Cuban coffee, eating white bread, watching television, listening to music and pleasant “chitchats.”
Counselors said the psychiatrist directed the therapy sessions, but he wasn’t even there, the undercover agent reported. Sessions, which lasted between 30 minutes to an hour, were billed as four hours.
The agent said that after a 10-minute evaluation, the psychiatrist wanted to hospitalize him. When he declined, the psychiatrist prescribed Prozac.
“The center operated as a sham,” said Steven Kogan, regional chief for the fraud unit.
The Little Havana clinic which opened in 1996, billed the Florida Agency for Health Care Administration an estimated $ 480,000 for Medicaid in its first year. By 1998, the clinic’s billings exceeded $ 1.2 million and the state froze the clinic’s bank accounts.
“Prometeo was paid $ 1.2 million in Medicaid funds last year for providing what appears to have been little or no meaningful therapy for its clients,” said Bob Butterworth, state attorney general.
After a seven-month investigation, the attorney general reported:
– The clinic gave $50 kickbacks to people willing to enroll as Medicaid eligible mental health clients.
– The clinic billed Medicaid for absent clients. One patient underwent major surgery at a hospital – the same days the clinic billed for a therapy session. Another patient was in jail for the billed days.
– The clinic billed for 16 days the agent attended, and for 17 days he didn’t.
– The clinic created fictitious psychiatric evaluations and bogus therapy notes.
The six people arrested at their homes Thursday were: co-owner Yolanda Aranzazu, 51; co-owner Lucila Bernal, 58; psychiatrist Dr. Francisco J. Borges, 71; office manager Martha Martinez, 44; counselor Graciela Noble, 56; and counselor Fernando Roche, 34.
Medicaid fraud is a third-degree felony that carries a maximum penalty of five years in jail and a $ 10,000 fine.