Medical Director for Miami-Based Health Care Clinic Sentenced to 144 Months in Prison for Role in $50 Million Medicare Fraud Scheme

A former medical director for Biscayne Milieu, a Miami-based mental-health clinic, was sentenced today to serve 144 months in prison for his role in a fraud scheme involving the submission of more than $50 million in fraudulent billings to Medicare, announced Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Michael B. Steinbach, Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami Office.

Dr. Gary Kushner, 72, of Plantation, Fla., was sentenced by U.S. District Judge Robert N. Scola Jr. in the Southern District of Florida. In addition to the prison term, Kushner was ordered to serve three years of supervised release.

Kushner was convicted on Aug. 28, 2012, of one count of conspiracy to commit health care fraud and one substantive count of health care fraud, following a two-month jury trial.

According to the evidence at trial, Kushner and his co-conspirators caused the submission of over $50 million dollars in false and fraudulent claims to Medicare through Biscayne Milieu, which purportedly operated a partial hospitalization program (PHP) – a form of intensive treatment for severe mental illness. Instead of providing legitimate PHP services, the defendants devised a scheme in which they paid patient recruiters to refer ineligible Medicare beneficiaries to Biscayne Milieu for services that were never provided or were not properly reimbursable by Medicare. Many of the patients admitted to Biscayne Milieu were not eligible for PHP because they were chronic substance abusers, suffered from severe dementia and would not benefit from group therapy, or had no mental health diagnosis but were seeking exemptions for their U.S. citizenship applications.

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