On February 10, 2022, a federal jury convicted a Florida doctor in the Southern District of Florida for a health care fraud scheme that billed private health insurance companies approximately $110 million for addiction treatment services that were not medically necessary. This was the second trial conviction to arise out of the Justice Department’s Sober Homes Initiative.
According to court documents and evidence presented at trial, Mark Agresti, M.D., 59, of Palm Beach, unlawfully billed approximately $110 million of urinalysis (UA) drug testing services that were medically unnecessary for patients at a sober living facility, Good Decisions Sober Living (GDSL). GDSL was paid kickbacks for providing patients to addiction treatment facilities in the West Palm Beach area, in violation of Florida state law.
Evidence presented at trial demonstrated that after Agresti became the Medical Director for GDSL, he agreed to provide standing orders for UA drug tests for GDSL patients in exchange for a monthly fee. Agresti also had GDSL patients sent to his medical office so he could fraudulently bill for services for these patients from his own medical practice. Patients at GDSL were required to submit to excessive, medically unnecessary urine drug tests as a condition of residency approximately three or four times per week. This added up to hundreds of UA drug tests per week and thousands per month. These UA drug tests cost as much as $6,000 to $9,000 per test. Agresti did not review the UA drug test results and did not use the UA drug tests to treat the GDSL patients. The evidence at trial showed that Agresti did the same thing at other addiction treatment facilities in the West Palm Beach area throughout the time of the charged conspiracy, resulting in hundreds of additional patients and thousands of additional fraudulent UA drug tests.
Three other defendants, including GDSL’s owner, were previously indicted and pleaded guilty to related charges in connection with this scheme.
Agresti was convicted of one count of conspiracy to commit health care fraud and wire fraud, as well as 11 counts of health care fraud. He is scheduled to be sentenced on April 21, 2022 and faces a maximum penalty 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 the U.S. Sentencing Guidelines and other statutory factors.
If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publically known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.
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