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Final healthcare worker sentenced in nation's largest mental health scam

Nursing assistant gets 12 years for involvement in $200 million fraud scheme

Miami certified nursing assistant Rodolfo Santaya, 55, was sentenced to more than 12 years in prison for his involvement in the largest mental health scam in U.S. history, according to the Miami Herald. The scheme totaled nearly $200 million in fraudulent Medicare payments.

Santaya and physician assistant Roger Bergman were both convicted in July, according to a Department of Justice (DOJ) statement. They represent the final two defendants in a case that sent nearly 40 to prison. Santaya was found guilty of recruiting patients that suffered from Alzheimer's and dementia and directing them to American Therapeutic Corp., based in Miami.

Santaya received hundreds of thousands in kickback payments for his role in the scheme, which generated $2.9 million in false claims, the Herald previously reported. In many cases, those patients did not qualify for or receive mental health treatment, but the company fabricated billing documents and reaped millions in reimbursement.

In October, Bergman was sentenced to 15 years for his role in the scheme.

The mental health industry in particular has been a target for Medicare and Medicaid schemes, FierceHealthPayer: AntiFraud previously reported. Former Department of Health and Human Services Inspector General Richard P. Kusserow has said that fraud investigators believe psychiatrists and psychologists have "the worst fraud record of all medical disciplines."

In August, for example, a Louisiana psychiatrist was sentenced to over seven years for his role in a $258 million fraud scheme. Meanwhile, in November, a COO of a psychiatric facility admitted to submitting false claims for mental health treatment between 2003 and 2012.

For more:
- read the Miami Herald article
- see the DOJ conviction

Related Articles:
Fraud charges dog corporate healthcare executives
Mental health scams target Medicare and Medicaid
Psychiatrist sent to prison for role in $258M fraud