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October 14, 2015

Owner and Operator of Miami-Based Mental Health Centers Pleads Guilty in $70 Million Health Care Fraud Scheme

WASHINGTON—An owner, a clinical director, and a therapist pleaded guilty today for their roles in a health care fraud scheme involving three Miami-based mental health centers.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Division and Special Agent in Charge Shimon Richmond of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Regional Office made the announcement.

Santiago Borges, 51, Erik Alonso, 45, and Cristina Alonso, 43, all of Miami, pleaded guilty before U.S. District Judge Ursula Ungaro of the Southern District of Florida. Borges pleaded guilty to conspiracy to commit health care fraud and conspiracy to defraud the United States and pay health care kickbacks. Erik Alonso pleaded guilty to conspiracy to commit health care fraud and conspiracy to make false statements relating to health care matters. Cristina Alonso pleaded guilty to conspiracy to commit health care fraud and conspiracy to make false statements relating to health care matters.

Borges owned the now-defunct mental health centers R&S Community Mental Health Inc. (R&S) and St. Theresa Community Mental Health Center Inc. (St. Theresa), and was an investor in New Day Community Mental Health Center LLC (New Day). Erik Alonso was the clinical director of all three centers. Cristina Alonso was a therapist at R&S.

R&S, St. Theresa and New Day were community mental health clinics that purported to provide intensive mental health services to Medicare beneficiaries in Miami. In connection with their guilty pleas, the defendants admitted that, from 2008 through 2010, the clinics billed Medicare for costly partial hospitalization program (PHP) services that were not medically necessary or not provided to patients. Borges admitted that he paid kickbacks to patient recruiters who, in exchange, referred beneficiaries to the centers. Erik Alonso admitted that he oversaw the preparation of false patient records. Cristina Alonso admitted that she fabricated patient records, including group therapy session notes that were used to support claims for reimbursement from Medicare.

According Borges’ plea agreement, between January 2008 and December 2010, the centers submitted more than $70 million in false and fraudulent claims to Medicare. Medicare paid approximately $28 million on those claims.

The case is being investigated by the FBI and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Southern District of Florida. This case is being prosecuted by Trial Attorney A. Brendan Stewart of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged over 2,300 defendants who collectively have billed the Medicare program for over $7 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.

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