Dr. Alan Gumer, 64, of Tamarac, Fla., pleaded guilty to one count of conspiracy to commit health care fraud after being charged on Feb. 15, 2011, along with 19 others involved in the scheme, on various counts of health care fraud, money laundering and other offenses.

Gumer was a psychiatrist at American Therapeutic Corporation (ATC), a Miami-based corporation that supposedly operated partial hospitalization programs (PHPs) in seven locations throughout South Florida and Orlando. Co-defendants included ATC; its management company, Medlink Professional Management Group Inc.; and the owners and lead manager of ATC, Medlink and the American Sleep Institute (ASI).

PHPs administer intensive treatment to patients suffering from severe mental illness, and Gumer admitted signing evaluations, notes and other medical documents for patients he knew didn’t need the intensive — and expensive — treatment for which ATC billed Medicare.

Gumer admitted signing papers without examining the patients or even writing and reading the statements he was signing. He also confessed to writing prescriptions for unnecessary psychiatric medications in order to fool Medicare into believing the patients qualified for PHP treatment.

The crooked doctor also referred hundreds of ATC patients to a related company and co-conspirator, ASI, for pointless diagnostic sleep disorder testing. Gumer’s co-defendants, ATC’s owners and operators, paid kickbacks to owners and operators of assisted living facilities (ALFs), halfway houses and patient brokers in exchange for ineligible patients which ATC and ASI could use to defraud Medicare. “Patients” sometimes received a cut of the kickbacks as well.

Overall, the ATC and ASI paid out millions of dollars in kickbacks in exchange for bogus Medicare beneficiaries who didn’t qualify for PHP services to attend illegitimate treatment programs so ATC and ASI could swindle Medicare for more than $200 million in unnecessary medically services.

Gumer’s role in the scheme was responsible for $19.3 million in fraudulent Medicare billing alone, and he faces a maximum of 10 years in prison and a $250,000 fine. Gumer’s sentencing is scheduled for January 2012.

ATC, its owners, and the lead manager of ATC, Medlink and ASI were charged with various counts of health care fraud, money laundering and other offenses in a separate superseding indictment unsealed on Feb. 15, 2011.

Two of the three ATC owners and the lead manager, as well as both ATC and Medlink, have pleaded guilty to more than $200 million in fraudulent Medicare billing and are scheduled for sentencing in September 2011. The trial of the third owner charged is scheduled to begin in August of this year. The remaining 17 co-defendants named in the indictment in which Gumer was charged are scheduled to stand trial in November 2011.

The case was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. Since its inception in March 2007, the Medicare Fraud Strike Force has charged more than 1,000 defendants who fraudulently billed Medicare for more than $2.3 billion.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.

URL: http://www.walletpop.com/2011/07/08/psychiatrist-pleads-guilty-in-200-million-medicare-kickback-sch/

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BUENOS AIRES, Argentina » A psychiatrist who has spent a lifetime traveling the world, meeting famous people and giving spiritual awareness lectures has been arrested in Argentina on charges of falsely billing $1 million in health insurance claims in Hawaii, authorities said Tuesday.

Dr. Carlos Livio Warter, 61, was arrested Monday afternoon at his home in a wealthy Buenos Aires neighborhood, where he had been working as a psychiatrist and leading seminars based on his latest book, “Pathways to the Soul.”

He will be extradited to the United States, said Osvaldo Magnoli, chief of fugitives investigations for Interpol in Argentina.

A Chilean-born naturalized U.S. citizen, Warter traveled regularly to Argentina, Chile and Hawaii, FBI special agent Tom Simon said in Honolulu.

Simon said FBI agents working out of the U.S. Embassy in Buenos Aires were coordinating with their Argentine counterparts on the extradition.

Warter says on his website that he has spent 30 years “journeying between the fields of western medicine and the deep exploration of spiritual practices from around the world,” doing his residency at Harvard University’s Children’s Hospital and later lecturing at Esalen Institute.

He has written dozens of books in Spanish and English, and his site shows photos of him meeting with world leaders from Robert F. Kennedy Jr. to the Dalai Lama, Pope John Paul II, Brazilian soccer legend Pele and former U.S. Secretary of State Colin Powell. The site says his nonprofit groups include the World Health Foundation for Development and Peace, Heartnet International and Gota de Miel (Drop of Honey), which aided orphanages in Latin America.

A federal grand jury indictment accuses Warter of knowingly sending about $1 million in inflated bills to Medicaid, the Hawaii Medical Service Association and TRICARE, a federally funded program that provides care to military personnel. It alleges he overbilled for sessions that didn’t last as long as he claimed, and even billed for sessions when he wasn’t physically in the state, pocketing more than $530,000 to which he wasn’t completely entitled.

In addition to the federal indictment, Warter was charged in August 2009 with 37 state felonies accusing him of Medicare fraud, each punishable by up to five years in prison. This February he voluntarily surrendered his medical license for failure to comply with professional conduct laws, said Connie Cabral, executive officer of the Hawaii Medical Board, which is attached to the state Department of Commerce and Consumer Affairs.

Argentine police said Warter, who is married and has four children, has been living for more than a year in Argentina. A woman answering his phone in Buenos Aires refused to comment Tuesday.

Jim Carter, listed by Warter as a U.S. contact for his seminars, said the arrest “has got me flabbergasted.”

“Everything I’ve done with him has been on the up and up, and he’s made a big positive impact on my life. I’m sure a lot of other people will say the same thing,” said Carter, who lives in the Lansing, Mich., area and began following Warter’s advice years ago.

“His day job is psychotherapy, and the other stuff he does is life coaching, with a spiritual bent,” Carter said. “A lot of his work is showing people how their ego is interfering, and to get that out of the way so their essence can grow.”

Associated Press writers Almudena Calatrava in Buenos Aires and Jennifer Kelleher and Mark Niesse in Honolulu contributed to this report.

URL: http://www.staradvertiser.com/news/hawaiinews/20110525_Psychiatrist_accused_of_overbilling.html

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A Kansas City psychiatric hospital with a history of patient-care problems failed to adequately monitor a suicidal patient, federal records show, and then bungled attempts to resuscitate her after she strangled herself with a strap.

Now the hospital faces federal sanctions.

The March 12 suicide is at least the second at Two Rivers Psychiatric Hospital since 2008.

Federal officials plan to drop Two Rivers from the Medicare program on Monday unless the hospital has adequate suicide precautions in place.

The 105-bed hospital at 5121 Raytown Road also faces a June 2 deadline to demonstrate to Medicare that it has taken care of several other serious problems, including keeping patients who’ve committed sex offenses away from other patients.

Termination means the government Medicare and Medicaid programs would no longer pay Two Rivers to care for patients. The measure is considered a last resort when medical facilities fail to meet critical standards.

“Two Rivers disputes any contention that there is an immediate jeopardy to patient safety,” Kevin Young, the hospital’s CEO, said Friday in a written statement.

“The hospital continues to participate in the Medicare program and is working diligently with (Medicare) and the Missouri Department of Health and Senior Services to demonstrate that the hospital is in compliance with the Medicare rules,” Young said. “We have instituted significant improvements and enhancements in patient care and safety.”

Medicare officials said Friday that they were awaiting the results of a recent inspection to see whether Two Rivers had improved its suicide precautions.

If Medicare and Medicaid are terminated, the programs will continue to pay Two Rivers for 30 days for patients already in the hospital, but not for new admissions. Provisions have been made to transfer Two Rivers patients to other hospitals, officials said.

Two Rivers is one of just a handful of in-patient psychiatric facilities in the area, and beds for people in crisis are in short supply, said Susan Crain Lewis, president of the advocacy group Mental Health America of the Heartland.

“Our community cannot afford to lose 105 beds,” Lewis said. “But individuals in our community who are struggling with a mental health issue can’t afford substandard treatment.”

Repeated problems

Two River opened about 25 years ago. For the past three years, the for-profit hospital has had repeated run-ins with Medicare.

“We have had intermittent issues with other psychiatric hospitals, but we don’t see them happen over and over,” said Jeri Jackson, an expert on psychiatric hospitals with the Kansas City office of the Centers for Medicare and Medicaid Services.

Two Rivers has faced Medicare decertification several times before, but has been able to correct problems to the satisfaction of federal officials.

Medicare began identifying chronic problems in May 2008, when a complaint about Two Rivers led to a visit by inspectors. They turned up an abuse case in which a staff member poured water over a patient’s head and another in which a nurse put a towel over an elderly patient’s mouth to stop the patient from screaming, according to inspection reports.

Another visit about six weeks later uncovered cases in which bed alarms had failed. One patient found on the floor at 3:12 a.m. had suffered a broken hip and shoulder, according to the Medicare reports.

Treatment plans showed that staff had failed to include suicide precautions for a patient who had thoughts of suicide, or physical therapy for a patient who had recent hip surgery.

In September 2008, an Army soldier committed suicide at the hospital by using bed linens to hang himself in a closet.

The soldier had been experiencing post-traumatic stress disorder and had attempted suicide before. That death triggered another investigation.

After the suicide, Medicare threatened to withhold money from Two Rivers. But the program agreed to continue paying if the hospital improved and an outside expert monitored its progress.

Early in 2009, inspectors examined medical records at Two Rivers and found little evidence that patients were receiving psychotherapy or medical treatment other than medications. In September 2010, the hospital refused the emergency admission of a teenager who had threatened to kill someone. Federal law requires hospitals to see emergency patients.

The teen’s caseworker already had signed admission paperwork at Two Rivers before the police van arrived with the patient. Three officers were needed to restrain the teen, who was placed in shackles.

Instead of admitting the youth, a staff member told the officers to take the teen to detention. The teen was admitted to another psychiatric hospital.

Recent suicide

The case that triggered the current threat of Medicare termination occurred a month ago.

The 59-year-old woman who took her own life had a history of depression, hallucinations, paranoid delusions and thoughts of suicide. She was transferred to Two Rivers from a nursing home on March 9 after she had asked her ex-husband to leave her in the woods to die. Two Rivers immediately placed her under suicide precautions.

Two days later, the patient became very agitated at the hospital, hitting the bathroom walls.

Two Rivers staff were supposed to check on her every 15 minutes. But surveillance videos showed that the patient went for 20 to 31 minutes without anyone looking in on her after midnight.

Hospital staff told inspectors that when they checked on the patient, her blanket was pulled up to her neck. She appeared to be sleeping.

The first sign something was wrong came shortly after 5 a.m. when the patient didn’t respond when asked to raise her arm for a blood pressure check. The surveillance video showed the staff member walking “casually” to the nurse’s station.

Two nurses went to the patient’s room. One started CPR while the other struggled to bring resuscitation equipment.

More nurses arrived at the patient’s room. They found the first nurse doing chest compressions on the patient. The second nurse stood by, nudging the patient’s feet and saying “wake up, wake up.”

Only as staff tried to give the patient oxygen did a nurse discover the two things around the patient’s neck that she had used to strangle herself. One was the black nylon strap of a wrist support. The other suicide device was a bright green stretchable ring toy used to provide sensory stimulation.

By this time, the patient’s face was mottled purple and gray from lack of oxygen. An automated external defibrillator was brought out to shock the patient’s heart to a steady beat. But it was too late.

URL:http://www.kansascity.com/2011/04/08/2787552/after-suicides-two-rivers-hospital.html

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