Federal court sentences Florida addiction recovery doctor to prison, to pay $31.3M in restitution after submitting $106M in fraudulent benefits claims

Federal court sentences Florida addiction recovery doctor to prison, to pay $31.3M in restitution after submitting $106M in fraudulent benefits claims
WEST PALM BEACH, FL – A federal court in Miami has sentenced the former medical director of a West Palm Beach residential addiction recovery center to prison and ordered more than $31 million in restitution paid as part of a healthcare scheme to obtain reimbursement for $106 million in false claims to more than 80 private insurance companies and federal healthcare benefit programs. The U.S. District Court for the Southern District of Florida sentenced Mark G. Agresti to 100 months in prison, and 36 months of supervised release. The court also ordered Agresti and his co-defendants to pay $31,041,938 in restitution. The action follows a multi-agency investigation that included the U.S. Department of Labor’s Employee Benefits Security Administration. It determined Agresti, then the medical director of Good Decisions Sober Living, submitted false and medically unnecessary tests for reimbursements to healthcare benefit plans. EBSA investigators found that – between September 2011 and December 2015 – Agresti and Good Decisions Sober Living owner Kenneth Bailynson falsely billed private insurance companies and federal healthcare benefit programs for reimbursement for fluid analysis used to evaluate the addiction recovery center’s residents. The schemes targeted dozens of employer-sponsored plans including the Amtrak Union Benefits Plan, the Bricklayers Insurance and Welfare Fund, and the Construction Workers Trust Fund. The investigation also found Bailynson co-conspired with Stephanie Curran and Matthew Noel who paid kickbacks and bribes to recruit patients from various sober homes in the area such as the Treatment Center of the Palm Beaches and Last Stop, to undergo fluid analysis drug testing at Good Decisions’ lab. As a result of the investigation, the court sentenced Curran and Noel on April 19, 2022, after both pleaded guilty on Feb. 20, 2020, to conspiracy to commit healthcare fraud. Curran was sentenced to 12 months and one day in prison, followed by 36 months of supervised release, and $11,294,277, in restitution with joint and several liability with others involved. Noel was sentenced to 14 months in prison, followed by 36 months of supervised release, and $8,673,925, in restitution with joint and several liability with the others involved. Bailynson was sentenced on April 20, 2022, to 72 months in prison, followed by 36 months of supervised release, and was ordered to pay $31,041,938 in restitution on June 24, 2022. He pleaded guilty on Nov. 8, 2021, to conspiracy to commit healthcare fraud. “Healthcare fraud erodes public trust and raises the cost of health insurance for all Americans,” said Acting Assistant Secretary for Employee Benefits Security Ali Khawar. “People who scheme to defraud healthcare plans and the companies that sponsor them increase the costs for everyone and may make it more difficult for people who need these services – to improve their physical and mental health – to obtain them. Today’s outcome demonstrates that the U.S. Department of Labor and its federal partners in enforcement will hold people like this accountable.” Good Decisions Sober Living in West Palm Beach claimed to be a residential recovery facility with the mission to provide a safe and drug-free home for people while they recover from alcohol and substance abuse disorders. The joint investigation was undertaken by the department’s Employee Benefits Security Administration, the FBI, IRS and the Department of Justice. Learn more about EBSA. 

Published at June 26, 2022 at 05:00PM
Read more at https://dol.gov