Miami Patient Recruiter

FL 2014 Behavioral Health
OIG Kickbacks Medicare Fraud
Penalty
$190 million

Outcome

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Details

Miami Patient Recruiter — $190,000,000 Criminal

Outcome: Official websites use .gov A .gov website belongs to an official government organization in the United States.

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( Lock A locked padlock ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

A patient recruiter for a fraudulent Miami-area mental health company, American Therapeutic Corporation (ATC), pleaded guilty today for her participation in a $190 million Medicare fraud scheme. Miami resident Mayelin Santoyo, 28, pleaded guilty before U.S. District Judge K. Michael Moore in the Southern District of Florida to one count of conspiracy to receive health care kickbacks. Sentencing has been scheduled for March 28, 2014.

HHS Office of Inspector General

How Crucible Prevents This

Crucible's billing compliance controls enforce documentation-to-claims reconciliation, requiring clinical attestation before claims submission and flagging billing patterns that deviate from documented care delivery. Crucible's referral monitoring tracks patient source patterns and flags arrangements that correlate referral volume with financial relationships, enforcing anti-kickback compliance documentation.

Source: Miami Patient Recruiter Pleads Guilty for Role in $190 Million Medicare Fraud Scheme

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