Physician assistant convicted in $200M Medicare fraud scheme

A federal jury in Miami has convicted Roger Bergman, a physician assistant licensed in Florida, and Rodolfo Santaya, a certified nursing assistant, for their involvement in a $200 million Medicare fraud scheme, according to the Department of Justice.

According to the lawsuit, Mr. Bergman, Mr. Santaya and their co-conspirators caused fraudulent claims to be submitted through Miami-based American Therapeutic Corporation — a mental healthcare company — to Medicare. The claims sought reimbursement for mental health services that were either not provided or provided to patients who were not eligible to receive the services.

Mr. Bergman allegedly created the fraudulent documents submitted to Medicare that made it appear ATC's patients qualified for the services they received. Mr. Santaya provided ineligible Medicare beneficiaries to ATC's office in exchange for hundreds of thousands of dollars in kickbacks.

The jury found Mr. Bergman guilty of conspiracy to commit healthcare fraud, wire fraud and conspiracy to make false statements relating to healthcare matters. Mr. Santaya was found guilty of conspiracy to commit healthcare fraud, wire fraud, conspiracy to pay and receive bribes and kickbacks and two counts of receiving bribes and kickbacks in connection with a federal healthcare benefit program.

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