A federal jury yesterday convicted a Florida doctor in the Southern District of Florida of a health care fraud scheme that billed private health insurance companies approximately $110 million for services to treat the drug addiction that were not medically necessary. This is the second sentencing at trial to stem from the Justice Department’s Sober Homes initiative.
According to court documents and evidence presented at trial, Mark Agresti, MD, 59, of Palm Beach, illegally billed approximately $110 million for urinalysis (UA) drug testing services that were medically unnecessary for patients at a sober living center, Good Decisions Sober Living (GDSL). GDSL received kickbacks for supplying patients to drug treatment centers in the West Palm Beach area, in violation of Florida state law.
“This defendant, a physician, 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 fraudulent scheme. He took advantage of people seeking drug treatment. His conviction further illustrates our commitment to protecting patients and prosecuting victims. owners, managers and operators of facilities who seek to exploit them, and highlights 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 of GDSL, he agreed to provide standing orders for UA drug testing for GDSL patients in exchange for a monthly fee. Agresti also had GDSL patients sent to his doctor’s office so that he could fraudulently bill for services for those patients from his own doctor’s office. GDSL patients had to submit to excessive and medically unnecessary urine drug testing as a condition of residence about three or four times a week. This added up to hundreds of UA drug tests per week and thousands per month. These UA drug tests cost up to $6,000 to $9,000 per test. Agresti has not reviewed UA drug test results and has not used UA drug tests to treat GDSL patients. Evidence at trial showed Agresti did the same thing at other West Palm Beach-area drug treatment centers throughout the indicted conspiracy, resulting in hundreds of additional patients and thousands of tests. additional fraudulent drug testing.
“This defendant used his medical license to facilitate a blatant multi-million dollar fraud scheme that exploited vulnerable drug addicts,” said U.S. Attorney Juan Antonio Gonzalez of the Southern District of Florida. “This bureau and its law enforcement partners are committed to holding accountable sober and unscrupulous landlords, doctors and others who engage in these fraudulent and abusive practices to satisfy their personal greed.”
“The defendant in this case exploited patients seeking drug treatment and pocketed the profits for years,” said Deputy Director Luis Quesada of the FBI’s Criminal Investigations Division. “This conviction is a warning that fraudulent practices such as 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 healthcare system and the people who depend on it.
“Patients place their faith and trust in industry professionals to care for their well-being,” 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 and going through unnecessary procedures to defraud the insurance companies. The IRS-CI is committed to fighting healthcare and other financial fraud, and we will hold criminals accountable for their illegal acts.
“Defendant exploited people in treatment for substance use disorders,” said Atlanta Regional Director Isabel Culver of the Employee Benefits Security Administration (EBSA) of the Ministry of Labour. “The U.S. Department of Labor is working to end illegitimate schemes like this and hold accountable those who commit health care fraud against employees’ benefit plan participants and their beneficiaries. .”
Three other defendants, including the owner of GDSL, have already been indicted and have pleaded guilty to charges related to the scheme.
Agresti was found guilty of one count of conspiracy to commit healthcare fraud and wire fraud, as well as 11 counts of healthcare fraud. He is due to be sentenced on April 21 and faces a maximum sentence 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 US sentencing guidelines and other statutory factors.
The FBI, IRS-CI and EBSA investigated the matter.
Senior Litigation Attorney 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 as part of the 2020 National Health Care Fraud Takedown to prosecute defendants who exploit vulnerable patients seeking treatment for substance abuse and / or alcoholism.