Medical Director Convicted in $110 Million Addiction Treatment Fraud Scheme

7 months ago
AMERICA NEWS NOW

A federal jury convicted a Florida doctor yesterday in the Southern District of Florida for a health care fraud scheme that billed private health insurance companies approximately $110 million for addiction treatment services that were not medically necessary. This is the second trial conviction to arise out of the Justice Department’s Sober Homes Initiative.

According to court documents and evidence presented at trial, Mark Agresti, M.D., 59, of Palm Beach, unlawfully billed approximately $110 million of urinalysis (UA) drug testing services that were medically unnecessary for patients at a sober living facility, Good Decisions Sober Living (GDSL). GDSL was paid kickbacks for providing patients to addiction treatment facilities in the West Palm Beach area, in violation of Florida state law.

“This defendant, a medical doctor, was trusted to provide care to vulnerable patients,” said Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department’s Criminal Division. “Instead, he abused his position of trust in a multimillion-dollar fraud scheme. He took advantage of people seeking addiction treatment. His conviction further illustrates our commitment to protecting patients and prosecuting the owners, directors and operators of facilities that seek to exploit them, and underscores the importance of the work of the Department of Justice’s Sober Homes Initiative.”

Evidence presented at trial demonstrated that after Agresti became the Medical Director for GDSL, he agreed to provide standing orders for UA drug tests for GDSL patients in exchange for a monthly fee. Agresti also had GDSL patients sent to his medical office so he could fraudulently bill for services for these patients from his own medical practice. Patients at GDSL were required to submit to excessive, medically unnecessary urine drug tests as a condition of residency approximately three or four times per week. This added up to hundreds of UA drug tests per week and thousands per month. These UA drug tests cost as much as $6,000 to $9,000 per test. Agresti did not review the UA drug test results and did not use the UA drug tests to treat the GDSL patients. The evidence at trial showed that Agresti did the same thing at other addiction treatment facilities in the West Palm Beach area throughout the time of the charged conspiracy, resulting in hundreds of additional patients and thousands of additional fraudulent UA drug tests.

“This defendant used his medical license to facilitate an egregious, multimillion-dollar fraud scheme that exploited vulnerable substance abusers,” said U.S. Attorney Juan Antonio Gonzalez for the Southern District of Florida. “This office and its law enforcement partners are committed to holding accountable the unscrupulous sober homeowners, doctors and others who carry out these fraudulent and abusive practices to satisfy their personal greed.”

“The defendant in this case exploited patients seeking treatment for addiction and pocketed the profits for years,” said Assistant Director Luis Quesada of the FBI’s Criminal Investigative Division. “This conviction is a warning that fraudulent practices like billing for medically unnecessary services come at a high cost. The FBI and our law enforcement partners are dedicated to protecting the integrity of America’s health care system and the people who rely on it.”

“Patients place their faith and trust on industry professionals to care for their wellbeing,” said Special Agent in Charge Matthew D. Line of IRS Criminal Investigation (IRS-CI), Miami Field Office. “Instead, in this case, they were taking advantage of, and submitted to unnecessary procedures to defraud insurance companies. IRS-CI is committed to combatting health care and other financial fraud, and we will hold criminals accountable for their unlawful actions.”

“The defendant exploited people in treatment for substance use disorders,” said Atlanta Regional Director Isabel Culver of the Department of Labor’s Employee Benefits Security Administration (EBSA). “The U.S. Department of Labor is working to end unconscionable schemes like this and hold those who commit health care fraud against employee benefit plan participants and their beneficiaries accountable.”

Three other defendants, including GDSL’s owner, were previously indicted and pleaded guilty to related charges in connection with this scheme.

Agresti was convicted of one count of conspiracy to commit health care fraud and wire fraud, as well as 11 counts of health care fraud. He is scheduled to be sentenced on April 21 and faces a maximum penalty of 20 years in prison for the health care fraud and wire fraud conspiracy count, and 10 years for each count of health care fraud. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

The FBI, IRS-CI and the EBSA investigated the case.

Senior Litigation Counsel Jim Hayes of the Criminal Division’s Fraud Section, and Assistant U.S. Attorney Amanda Perwin for the Southern District of Florida are prosecuting the case.

The Criminal Division’s Fraud Section leads the Department of Justice’s Sober Homes Initiative, which was announced in the 2020 National Health Care Fraud Takedown to prosecute defendants who exploit vulnerable patients seeking treatment for drug and/or alcohol addiction.

Read Entire Article