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From Health Law Daily, April 26, 2013

Supervisor of a mental health care company found guilty of conspiracy to commit health care fraud

By Geri Szuberla, JD, LLM

A Health Care Solutions Network (HCSN) supervisor in the Miami area, was convicted for helping to orchestrate a fraud scheme that crossed state lines and resulted in the submission of more than $63 million in fraudulent claims to Medicare and Florida Medicaid, according to a Department of Justice (DoJ) press release.

After a five-day trial, a jury in the Southern District of Florida found Wondera Eason guilty of conspiracy to commit health care fraud. Eason was employed as the Director of Medical Records at HCSN’s Partial Hospitalization Program (PHP). A PHP is a form of intensive treatment for severe mental illness. In Florida, HCSN operated community mental health centers at two locations. After stealing millions from Medicare and Medicaid in Florida, HCSN’s owner, Armando Gonzalez, exported the scheme to North Carolina, opening a third HCSN location in Hendersonville, according to the DoJ.

Medical records. Evidence at trial showed that at all three locations, Eason, a certified medical records technician, oversaw the alteration, fabrication, and forgery of thousands of documents, which purported to support the fraudulent claims HCSN submitted to Medicare and Florida Medicaid. Many of these medical records were created weeks or months after the patients were admitted to HCSN facilities in Florida for purported PHP treatment and were utilized to support false and fraudulent billing to government sponsored health care benefit programs, including Medicare and Florida Medicaid.

Eason directed therapists to fabricate documents, and she also forged the signature of therapists and others on documents that she was in charge of maintaining, the DoJ said. Eason interacted with Medicare and Medicaid auditors, providing them with false and fraudulent documents, while certifying the documents were accurate. The “therapy” at HCSN oftentimes consisted of nothing more than patients watching Disney movies, playing bingo and having barbeques. Eason directed therapists to remove any references to these recreational activities in the medical records, according to DoJ.

Kickbacks. Evidence at trial showed that Eason was aware HCSN in Florida paid illegal kickbacks to owners and operators of Miami-Dade County Assisted Living Facilities (ALF) in exchange for patient referral information to be used to submit false and fraudulent claims to Medicare and Medicaid. Eason also knew, according to DoJ, that many of the ALF referral patients were ineligible for PHP services because many patients suffered from mental retardation, dementia and Alzheimer's disease.

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