Medical Director for Miami-Based Health Care Clinic Sentenced to 144 Months in Prison for Role in $50 Million Medicare Fraud Scheme

WASHINGTON—A former medical director for Biscayne Milieu, a Miami-based mental-health clinic, was sentenced today to serve 144 months in prison for his role in a fraud scheme involving the submission of more than $50 million in fraudulent billings to Medicare, announced Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Michael B. Steinbach, Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami Office.

Dr. Gary Kushner, 72, of Plantation, Florida, was sentenced by U.S. District Judge Robert N. Scola, Jr. in the Southern District of Florida. In addition to the prison term, Kushner was ordered to serve three years of supervised release.

Kushner was convicted on August 24, 2012, of one count of conspiracy to commit health care fraud and one substantive count of health care fraud, following a two-month jury trial.

According to the evidence at trial, Kushner and his co-conspirators caused the submission of over $50 million dollars in false and fraudulent claims to Medicare through Biscayne Milieu, which purportedly operated a partial hospitalization program (PHP)—a form of intensive treatment for severe mental illness. Instead of providing legitimate PHP services, the defendants devised a scheme in which they paid patient recruiters to refer ineligible Medicare beneficiaries to Biscayne Milieu for services that were never provided or were not properly reimbursable by Medicare. Many of the patients admitted to Biscayne Milieu were not eligible for PHP because they were chronic substance abusers, suffered from severe dementia and would not benefit from group therapy, or had no mental health diagnosis but were seeking exemptions for their U.S. citizenship applications.

The evidence at trial further showed that, as Biscayne Milieu’s medical director, Kushner authorized the treatment of patients that he knew were ineligible for PHP treatment. Biscayne Milieu then billed Medicare for millions of dollars in PHP treatments for these patients under Kushner’s name. Evidence further revealed that Kushner would often conduct cursory examinations lasting only minutes before authorizing such fraudulent billings.

Various owners, doctors, managers, therapists, patient brokers, and other employees of Biscayne Milieu have also been charged with various health care fraud, kickback, money laundering, and other offenses in two indictments unsealed in September 2011 and May 2012. Biscayne Milieu, its owners, and more than 25 of the individual defendants charged in these cases have pleaded guilty or have been convicted at trial. Antonio and Jorge Macli and Sandra Huarte—the owners and operators of Biscayne Milieu—were each convicted at trial of various offenses and are scheduled for sentencing in April 2013.

This case is being prosecuted by Assistant U.S. Attorneys Michael Davis, Marlene Rodriguez and James V. Hayes of the U.S. Attorney’s Office for the Southern District of Florida; James V. Hayes was formerly a Trial Attorney in the Criminal Division’s Fraud Section. The case was investigated by the FBI with the assistance of HHS-OIG and was brought by the U.S. Attorney’s Office for the Southern District of Florida in coordination with the Medicare Fraud Strike Force, supervised by 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 more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is 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.