The Miami Herald
South Florida psychiatrist pleads guilty to massive Medicare fraud
By JAY WEAVER
South Florida psychiatrist Alan Gumer got in near the start of the nation’s largest mental-health clinic racket in 2004, signing bogus medical evaluations to qualify patients for costly group therapy sessions covered by Medicare.
“At times,’’ Gumer also “prescribed psychiatric medications to individuals who did not need them to make it appear to Medicare that the patients’’ qualified for treatment, according to federal court documents.
On Thursday, Gumer, 64, of Tamarac pleaded guilty to Medicare fraud for his critical role in a massive, $200 million scheme. The racket enabled Miami-based American Therapeutic Corp. to bill the government program for psychotherapy that was unnecessary for thousands of patients who faked suffering from depression, schizophrenia or bipolar conditions.
Justice Department lawyer Jennifer Saulino said Gumer was responsible for $19.3 million in false claims filed on behalf of the patients, who were paid kickbacks by the American Therapeutic chain of South Florida clinics. Asked by U.S. District Judge Patricia Seitz why he pleaded guilty, Gumer said: “It’s the right thing to do.”
Gumer became the first doctor among three psychiatrists indicted in the American Therapeutic case to admit playing such a dominant part in the seven-year scam, which netted $83 million in Medicare payments for the company. He and two other psychiatrists, Dr. Mark Willner of Weston and Dr. Alberto Ayala of Miami-Dade, served as the company’s medical directors.
All three were accused of altering diagnoses and medications to make it look like the patients qualified for purported group therapy sessions at the chain’s seven clinics in Miami-Dade, Broward and Palm Beach counties. Willner and Ayala have pleaded not guilty.
Gumer faces between six and seven years in prison under sentencing guidelines for pleading to one count of conspiring to defraud the taxpayer-funded Medicare program, according to his attorney William Pearson. Gumer, who remains free on bond, is scheduled for sentencing on Jan. 19.
But because he is cooperating with authorities, Justice Department lawyers are expected to recommend that he receive a sentence reduction in the future, according to his plea agreement. Prosecutors dropped four other healthcare fraud charges as part of the deal.
Since last fall, 24 American Therapeutic employees and others have been charged in the sprawling investigation by the FBI and Internal Revenue Service, which originated as a whistle-blower case.
In April, the top executives of American Therapeutic, Lawrence S. Duran and Marianella Valera, pleaded guilty. Duran, 49, and Valera, 40, both of Miami and now in custody, owned the chain of mental health clinics.
During the past decade, their company was paid $83 million by Medicare for group therapy sessions that thousands of patients either didn’t need or receive — including some with dementia and Alzheimer’s disease who could not have benefited from the treatments.
The company’s marketing director, Margarita Acevedo, 41, became the first defendant to plead guilty when she admitted that she played a supporting role in the conspiracy. Acevedo, who is cooperating with authorities as part of her plea agreement, said she paid millions in kickbacks to South Florida recruiters associated with assisted-living facilities and halfway houses in exchange for supplying therapy services to patients who didn’t need them.