April 10, 2013 Healthcare Fraud
Shocking Medicare Fraud Trial Comes to an End as Participants are Sentenced
The owners and operators of a Miami-based mental health clinic and the facility itself were recently convicted for participating in a wide-reaching Medicare fraud scheme. The mental health facility, Biscayne Milieu, submitted more than $50 million in fraudulent invoices to Medicare. The defendants were convicted of conspiracy to commit healthcare fraud and conspiracy to offer and pay kickbacks after a lengthy two-month jury trial in Florida.
Details of the Medicare Fraud
During the trial, the prosecution showed that Biscayne Milieu was a dummy-clinic operated by one family. Antonio Macli and his son Jorge Macli were the respective owners of the facility, while Antonio Macli’s daughter Sandra Huarte was an executive at the clinic. The entire family unit created and ran an elaborate Medicare scheme, along with the participation of several co-defendants, in which they submitted false and fraudulent claims through Biscayne Milieu.
Biscayne Milieu reportedly operated what is called a Partial Hospitalization Program, which essentially provides intensive out-patient services for patients with severe mental illnesses. The family devised a scheme in which they paid a group of “patient recruiters” to refer ineligible patients to the facility for services that were never provided or medically unnecessary. In fact, many of the patients who were recruited for treatment at the Biscayne Milieu facility were not eligible for PHP services under Medicare guidelines due to the fact they were chronic drug and alcohol abusers or they were seeking to find a physician who would voluntarily diagnose them with mental illness in order to get an exemption from the civics section of the United States citizenship application process.
Antonio and Jorge Macli, along with Huarte, paid their patient recruitment group over $1 million in illegal kickbacks for gathering these ineligible patients and bringing them into Biscayne Milieu for “treatment.” In turn, the facility then billed Medicare for millions of dollars in PHP treatments that they were not entitled to.
While the practice of Medicare fraud may not be uncommon, the Biscayne Milieu group took things to a new level in this massive scheme by actually hiring doctors, therapists and various nursing staff to promote their money-making plans. They created fake medical records and case manager contracts in an effort to make it extremely difficult for anyone to trace the fraudulent activity back to their front door.
How it All Started
The ring leader and mastermind of this Medicare fraud scheme was Antonio Macli. Once he crafted the plan, he enlisted his son and daughter to participate. Antonio Macli had control over each of the clinic’s bank accounts, which all received millions of dollars in stolen Medicare funds. A large bulk of that money was then put toward paying massive illegal kickback fees that accrued as a result of the family’s extensive fraud network.
While Antonio was the brains of the operation, Jorge Macli was responsible for its day-to-day operation. Jorge worked on a daily basis to conceal and further the Medicare fraud scheme, including his efforts to avert resolving any patient or staff complaints about the treatment they received at Biscayne Milieu. Jorge went a step further in his “customer service” mission and paid multiple bribes to patients in exchange for their silence.
Sandra Huarte’s job at Biscayne Milieu was to oversee that the illegal kickbacks were paid on time and the fraudulent Medicare bills for the clinic were submitted in a timely fashion. Huarte also made sure that Biscayne Milieu’s fraudulent Medicare claims would be able to stand up to scrutiny by creating an elaborate trail of fraudulent paperwork and medical files. She also solicited other Biscayne Milieu employees to follow her lead, ensuring each of the false claims were paid.
A Tangled Web
As one of the most elaborate and tangled Medicare fraud schemes Florida has seen, the evidence in court further showed that the entire family used a series of seemingly-legitimate corporations to conceal and launder Biscayne Milieu’s fraudulent profits. In addition to the family members, an additional 25 co-defendants have been charged in this Medicare fraud case.
Antonio and Jorge Macli, along with Sandra Huarte, were all sentenced by United States District Judge Robert N. Scola Jr. of the Southern District of Florida. Antonio Macli was sentenced to serve a prison term of 360 months; Jorge Macli was sentenced to 300 months; and Huarte received a sentence of 262 months. In addition, Biscayne Milieu, the corporate entity, was sentenced to serve one year of probation. Antonio Macli, Jorge Macli and Huarte will each have to serve three years of supervised probation upon their release from prison.
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