Attorneys say a former health care clinic director and licensed therapist pleaded guilty Thursday in connection with a health care fraud scheme involving defunct health provider Health Care Solutions Network Inc.
According to attorneys, 66-year-old Paul Thomas Layman pleaded guilty before U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida to one count of conspiracy to commit health care fraud.
Layman's co-conspirator Dana Gonzalez, 43, a registered clinical social worker intern in Florida, pleaded guilty Wednesday to one count of conspiracy to commit health care fraud for her role in the scheme, said attorneys.
During the course of the conspiracy, attorneys said Layman was employed as a substance abuse counselor, therapist and clinical director of HCSN's Partial Hospitalization Program. A PHP is a form of intensive treatment for severe mental illness.
In Florida, attorneys said HCSN operated community mental health centers at three locations. During his employment, Layman worked full time at all HCSN locations in Florida in various capacities, said attorneys.
According to court documents, Layman was aware that HCSN in Florida paid illegal kickbacks to owners and operators of Miami-Dade County Assisted Living Facilities in exchange for patient referral information to be used to submit false and fraudulent claims to Medicare and Medicaid.
Attorneys said Layman also knew that many of the ALF referral patients were ineligible for PHP services because many patients suffered from mental retardation, dementia and Alzheimer's disease.
Court documents further revealed that Layman was aware that HCSN personnel in Florida were fabricating patient medical records.
Attorneys said 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.
During his employment at HCSN in Florida, attorneys said Layman signed fabricated PHP therapy notes and other medical records used to support false claims to government sponsored health care programs.
HCSN also operated one location in Hendersonville, N.C. At the Hendersonville location, attorneys said Layman served as the clinical director and assisted HCSN owner Armando Gonzalez in obtaining necessary licensing, credentials and Medicare authorizations for HCSN.
According to court documents, from 2008 through 2009, Layman purportedly supervised therapists at HCSN in Hendersonville, including Alexandra Haynes, who was an unlicensed therapist purportedly performing PHP therapy to HCSN patients.
For their roles in the conspiracy, attorneys said Gonzalez pleaded guilty to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering, and Haynes pleaded guilty to one count of conspiracy to commit health care fraud.
On Monday, Feb. 25, Gonzalez was sentenced to serve 168 months in prison for his role in the scheme.
According to court documents, Dana Gonzalez worked at HCSN in Florida from approximately April 2005 through December 2010.
At HCSN in Florida, attorneys said Gonzalez fabricated patient medical records, which were used to support false and fraudulent billing to Medicare and Florida Medicaid.
In 2011, Gonzalez worked at HCSN in North Carolina, where attorneys said she fabricated therapy notes and medical records, and provided unlicensed therapy when licensed therapists were absent.
According to court documents, from 2004 through 2011, HCSN billed Medicare and the Florida Medicaid program approximately $63 million for purported mental health services.
Attorneys said 15 defendants have been charged for their alleged roles in the HCSN health care fraud scheme, and 12 defendants have pleaded guilty.
Alleged co-conspirator Wondera Eason is scheduled for trial on April 22, 2013, before Judge Altonaga in Miami. Alleged co-conspirators Alina Feas and Lisset Palmero are scheduled for trial on June 3, 2013. Defendants are presumed innocent until proven guilty at trial.