A federal jury convicted a Florida physician the other day in the Southern District of Florida for a health care fraud scheme that billed personal health insurance business around $110 million for addiction treatment services that were not medically needed. This is the 2nd trial conviction to develop out of the Justice Department’s Sober Houses Effort.
According to court files and proof provided at trial, Mark Agresti, M.D., 59, of Palm Beach, unlawfully billed around $110 million of urinalysis (UA) drug screening services that were medically unneeded for patients at a sober living facility, Great Choices Sober Living (GDSL). GDSL was paid kickbacks for offering patients to addiction treatment centers in the West Palm Beach location, in infraction of Florida state law.
” This offender, a medical physician, was relied on to provide care to susceptible patients,” stated Assistant Chief law officer Kenneth A. Polite Jr. of the Justice Department’s Bad guy Department. “Rather, he abused his position of trust in a multimillion-dollar fraud scheme. He capitalized of people looking foraddiction treatment His conviction even more shows our dedication to safeguarding patients and prosecuting the owners, directors and operators of centers that seek to exploit them, and highlights the significance of the work of the Department of Justice’s Sober Houses Effort.”
Proof provided at trial showed that after Agresti ended up being the Medical Director for GDSL, he concurred to provide standing orders for UA drug tests for GDSL patients in exchange for a month-to-month cost. Agresti likewise had GDSL patients sent out to his medical workplace so he might fraudulently expense for services for these patients from his own medical practice. Patients at GDSL were needed to send to extreme, medically unneeded urine drug evaluates as a condition of residency around 3 or 4 times each week. This built up to hundreds of UA drug tests each week and thousands each month. These UA drug tests cost as much as $6,000 to $9,000 per test. Agresti did not examine the UA drug test outcomes and did not use the UA drug tests to deal with the GDSLpatients The proof at trial revealed that Agresti did the exact same thing at other addiction treatment centers in the West Palm Beach location throughout the time of the charged conspiracy, resulting in hundreds of extra patients and thousands of extra deceitful UA drug tests.
” This offender used his medical license to assist in an outright, multimillion-dollar fraud scheme that made use of susceptible substance abusers,” stated U.S. Lawyer Juan Antonio Gonzalez for the Southern District of Florida. “This workplace and its police partners are devoted to holding liable the unethical sober house owners, physicians and others who perform these deceitful and violent practices to please their individual greed.”
” The offender in this case made use of patients looking for treatment for addiction and swiped the revenues for years,” stated Assistant Director Luis Quesada of the FBI’s Bad guy Investigative Department. “This conviction is a caution that deceitful practices like billing for medically unneeded services come at a highcost The FBI and our police partners are committed to safeguarding the stability of America’s health care system and the people who rely on it.”
” Patients put their faith and trust on market professionals to care for their health and wellbeing,” stated Unique Representative in Charge Matthew D. Line of Internal Revenue Service Lawbreaker Examination (IRS-CI), Miami Field Workplace. “Rather, in this case, they were capitalizing of, and sent to unneeded treatments to defraud insurance business. IRS-CI is devoted to fighting health care and other financial fraud, and we will hold crooks liable for their illegal actions.”
” The offender made use of people in treatment for substance use disorders,” stated Atlanta Regional Director Isabel Culver of the Department of Labor’s Worker Benefits Security Administration (EBSA). “The U.S. Department of Labor is working to end unconscionable plans like this and hold those who dedicate health care fraud versus worker advantage plan individuals and their recipients liable.”
3 other accuseds, consisting of GDSL’s owner, were formerly prosecuted and pleaded guilty to associated charges in connection with this scheme.
Agresti was convicted of one count of conspiracy to dedicate health care fraud and wire fraud, in addition to 11 counts of health care fraud. He is set up to be sentenced on April 21 and deals with an optimum charge of twenty years in jail for the health care fraud and wire fraud conspiracy count, and ten years for each count of health care fraud. A federal district court judge will identify any sentence after thinking about the U.S. Sentencing Standards and other statutory elements.
The FBI, IRS-CI and the EBSA examined the case.
Senior Lawsuits Counsel Jim Hayes of the Bad guy Department’s Fraud Area, and Assistant U.S. Lawyer Amanda Perwin for the Southern District of Florida are prosecuting the case.
The Bad guy Department’s Fraud Area leads the Department of Justice’s Sober Houses Effort, which was revealed in the 2020 National Health Care Fraud Takedown to prosecute accuseds who make use of susceptible patients looking for treatment for drug and/or alcohol addiction