Employee Gets 8 Years for Facilitating Employer's Fraud

A former clinical director for Biscayne Milieu, a Miami-based mental-health clinic, was sentenced to more than eight years in prison for helping his employer commit Medicare fraud.

Rafael Alalu is just the latest person whose life has been devastated because he went along with his employer’s fraud.  So far, the owners of Biscayne Milieu and more than 25 doctors, managers, therapists, and other employees have pleaded guilty or have been convicted at trial.

Biscayne Milieu purportedly operated a partial hospitalization program (PHP) – a form of intensive treatment for severe mental illness.  According to the government, the clinic submitted more than $50 million in false and fraudulent claims to Medicare for individuals who were not eligible for PHP or who never received treatment.

Many of the patients were not eligible for PHP because they were chronic substance abusers or suffered from severe dementia and would not benefit from group therapy.  Other patients had no mental health diagnosis and never intended to get treatment.

Mr. Alalu, the clinical director, was convicted of treating ineligible patients and helping to conceal the fraud by falsifying patient files, writing fraudulent group therapy notes, and instructing others to do the same.  His participation in the mental health fraud earned him an eight-year prison term.

This is a very sad situation, especially for the employees.  Mr. Alalu and his co-workers not only could have avoided prison, but could have earned substantial rewards if they had consulted with an experienced False Claims Act attorney.

The False Claims Act provides legal protections and substantial rewards to whistleblowers who help the government uncover fraud.  Under the qui tam provisions of the law, an individual citizen can start a lawsuit on behalf of the government to recover for false and fraudulent claims.  The lawsuit is initially filed “under seal” (in secret) to give the government an opportunity to conduct an investigation.

A False Claims Act whistleblower, who is called a “relator,” is entitled to a reward of up to 30% of the amount the government actually collects.  In this case, the reward could have amounted to more than $1 million.  Unfortunately, the employees are going to prison instead because they chose to go along with the fraud.

Do not go to prison for your employer’s fraudulent or false claims.  If you are aware that false medical records are being created or false claims are being submitted to Medicare or Medicaid, then you should consult with an experienced False Claims Act attorney immediately to protect your rights.  You may be eligible for whistleblower protections and a very substantial reward.

Call John Howley, Esq. at (917) 652-6504 to arrange a free and confidential consultation, or click here to reach our offices via email.  There are no legal fees unless your case is successful.

John Howley, Esq.

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