A Miami couple who owned a South Florida chain of mental health clinics face spending the rest of their lives in prison for ripping off millions from Medicare.
By Jay Weaver
September 13, 2011
Lawrence Duran was a Miami healthcare executive who regularly lobbied Congress in favor of legislation to boost government subsidies for his industry: community mental health centers. He visited with U.S. Rep. Ileana Ros-Lehtinen in Washington to drum up support. He, his girlfriend and other members of his lobbying organization threw a fundraiser for another Miami congressman, Rep. Kendrick Meek, when he ran for the U.S. Senate.
But Justice Department officials paint a far more sinister portrait of Duran and his girlfriend, Marianella Valera. They say the lobbying work was all a front to help them steal more money from the taxpayer-funded Medicare program.
Now Duran and Valera, who each pleaded guilty this year to Medicare fraud charges of running the biggest mental-health racket in the nation, face the prospect of spending the rest of their lives in prison for orchestrating the $205 million scam.
If U.S. District Judge James Lawrence King sides with prosecutors at a sentencing hearing Wednesday, Duran, 49, and Valera, 40, could be imprisoned for 50 and 40 years, respectively. Those sentences would be the longest prison terms ever for Medicare fraud offenders in the country, surpassing 30 years given to a convicted Miami doctor for her role in an $11 million HIV-therapy scheme.
Duran and Valera, who once lived together in a waterfront condo, traveled overseas and owned luxury cars, co-owned American Therapeutic Corp. Until the feds shut down the Miami-based company last October, it operated a chain of seven mental-health clinics in South Florida and Orlando that duped Medicare into paying the couple’s business $87 million during the past decade.
Their lawyers, Lawrence Metsch and Arthur Tifford, contend that they should only be held liable for that loss to the federal healthcare program — not the $205 million in fraudulent claims their company submitted to Medicare.
The loss amount, depending on how the judge rules, will be a major factor in their sentencings.
In the past year, Duran and Valera were charged along with 32 other American Therapeutic employees, psychiatrists, counselors, nurses, marketers, patient recruiters and others who supplied Medicare beneficiaries in exchange for kickbacks. American Therapeutic billed Medicare for thousands of patients, including many with dementia and Alzheimer’s disease, who had no way of benefiting from the company’s costly group-therapy sessions, prosecutors said.
Duran and several of the employees also held “charting” parties, where they would falsify the medical records of beneficiaries to make it look like they needed therapy when they actually didn’t.
About a dozen of the defendants have been convicted, including Duran and Valera’s top aides, Margarita Acevedo, who ran the marketing operation to bring in patients, and Judith Negron, who was in charge of a subsidiary, MedLink, which laundered Medicare profits to pay employees and kickbacks. Another employee, Joseph Valdes, who worked under Acevedo, also pleaded guilty.
Justice Department lawyers are seeking such an extraordinarily high sentence for Duran partly because of his role as a board member of the National Association for Behavioral Health. The Washington, D.C. coalition was established to lobby Congress on behalf of clinics that purportedly provided services to the mentally ill, prosecutors said.
The group’s brochure said it was founded in 2006 with the “express purpose of fighting what would have been devastating cuts to” community mental-health centers, such as Duran’s business, American Therapeutic.
In October 2009, Duran authored a letter to the mental health operators nationwide, expressing concern about the closure of some community clinics, Medicare’s heightened scrutiny of payments and future reimbursement rates.
“We must continue to work together to protect the benefit and our patients who so desperately need our services,” Duran wrote.
The Justice Department, however, said in court papers that the organization aided Duran’s criminal conspiracy, which resulted in Medicare millions for his business, co-owned with Valera, a licensed mental-health counselor.
Little of that money has been recovered by the FBI, Health and Human Services and Internal Revenue Service.
“In actuality, NABH was an organization that provided Duran a legitimate-looking vehicle to lobby Congress to allocate more money, through Medicare, to Duran and his co-conspirators for their fraudulent claims,” Justice Department lawyer Jennifer Saulino wrote in a recent court filing.
“He directed NABH staff to disseminate to other [community mental health centers] the tricks of his trade,” Saulino wrote, noting how he instructed others “on ways in which to win appeals of Medicare denials of claims, based on ATC’s experience.”
Duran’s company also wrote four checks to NABH totaling $49,500.
Last week, another Miami member of the lobbying organization, Biscyane Milieu Health Center, was implicated in an indictment charging its owners and about 20 others with Medicare fraud.
The organization sponsored a Miami political fundraiser for Meek in October 2009, because he was an advocate for the mentally ill and supported President Barack Obama’s healthcare reform legislation.
As part of their bid to boost Duran’s prison sentence, prosecutors filed a picture of him with Valera, Negron, Acevedo and Valdes at the Meek fundraiser.
A former Meek campaign aide told The Miami Herald that the congressman did not solicit the support of Duran’s lobbying organization. Rather, a Meek supporter knew Duran and coordinated the group’s fundraiser for the congressman, who went on to win the Democratic primary for the U.S. Senate but lost in the general election last year.
“Congressman Meek met Duran for the first time at the fundraiser,” said the former aide.