Medical Fraud Scheme in South Florida

April 28, 2022 Don Pumphrey, Jr. Criminal Defense Social Share

A massive medical fraud scheme case has been investigated and uncovered in South Florida. The head of the fraud now faces charges of one count of conspiracy to commit health care fraud and wire fraud, along with 11 other counts of health care fraud. What was supposed to be a patient recovery center for people recovering from alcohol and drugs instead became a money-making scandal.

We will cover the case and its various defendants, as well as what the responses have been.

What was the Medical Fraud Case?

Mark Agresti, 59, a South Florida medical doctor is now facing decades in prison after being accused of a medical fraud scheme reaching $110 million in drug tests. The fraud scheme took place in a sober living facility called Good Decisions Sober Living (GDSL), in a rundown condo complex in West Palm Beach, Florida.

According to the Department of Justice’s document, Agresti was billing for addiction treatment services that were not medically necessary. GDSL violated Florida state laws by getting paid kickbacks for providing patients to addiction treatment facilities in West Palm Beach.

The evidence at the trial showed that Agresti agreed to provide standing orders for UA drug tests for the GDSL patients once he became medical director. He would fraudulently bill patients for services from his practice, and required them to submit excessive urine drug tests three to four times a week as the residency requirement. Each test could cost as much as $6,000 to $9,000. The urine drug tests were deemed unnecessary, and Agresti did not even review the tests in the treatment for his patients. Agresti was accused of doing the same thing at other addiction facilities around West Palm Beach.

Assistant Attorney General Kenneth A. Polite Jr. from the Department of Justice’s Criminal Division had the following to say about Agresti:

“This defendant, a medical doctor, was trusted to provide care to vulnerable patients. Instead, he abused his position of trust in a multimillion-dollar fraud scheme. He took advantage of people seeking addiction treatment. His conviction further illustrates our commitment to protecting patients and prosecuting the owners, directors, and operators of facilities that seek to exploit them, and underscores the importance of the work of the Department of Justice’s Sober Homes Initiative.”

There were three other defendants in the case, which includes Kenneth Bailynson, GDSL’s owner. As of April 20^th, 2022, a federal judge sentenced Bailynson to six years behind bars for his involvement in the medical fraud scheme.

U.S. District Judge Rodolfo A. Ruiz II claimed he was reluctantly giving Bailynson a lenient sentence only after he assisted in testifying against Agresti. Bailynson pled guilty to one count of conspiracy to commit health care fraud and had federal prosecutors drop the additional 13 charges he was facing once he agreed to help as a witness in Agresti’s case.

Bailynson’s testimony was a key figure in the conviction of 12 charges of health care fraud against Agresti. Although Judge Ruiz found Bailynson helpful in the case against Agresti, he admitted that the comment about what drove Bailynson to commit fraud still haunts him:

“I can’t get out of my head what you said and I think I can quote it exactly. You said, ‘If you didn’t catch me I would have made $2 billion.’ The amount of avarice and greed that was illustrated was stunning to me.”

Medicaid Fraud in Florida

Under Florida Statute Section 409.920, Medicaid fraud is when an individual or company makes a false representation of a material fact in any claim submitted to the agency or its fiscal agent. The following is a list of potential medical fraud schemes:

• Overbilling for medical services
• “Phantom billing” for medical services that were never performed
• Up-coding or billing for expensive medical services instead of billing for the less expensive procedure performed
• Billing for medical tests or services that were not necessary

To read more about Medicaid fraud and the potential penalties in the state of Florida, find our blog post here.

Responses

Unlike Bailynson’s sentence, the responses so far in this case have been anything but lenient. Judge Ruiz addressed Bailynson in the courtroom:

“You are an extremely smart young man and you have squandered your gifts. It is a depressing fact because who knows what you could have accomplished and still can…But you are a greedy person with a lot of anger. There is a part of you that needs a lot of work.”

Sharon O’Brien, the mother of a deceased patient, testified via zoom. She scoffed at Bailynson’s plea for mercy and his claim that he is now a changed man. “It sickens me to hear him talk about how he can’t see his son,” O’Brien said. “My son is deceased. He died 13 days after he came home from [Bailynson’s] treatment center…My son finally wanted to embrace getting sober, [and] I did everything I could to help him get to Florida.”

One of the members of the community, Frank Kundra, expressed his worry about Bailynson’s release from prison. “He destroyed the entire community. I’m afraid of him, I’m very much afraid of him. He sues people for sport.” Bailynson was known for slapping lawsuits at anyone who got in his way—some even continuing to this day.

Finding a Medicaid Fraud Attorney in Tallahassee, Florida

Any type of fraud is a serious crime in Florida. It is especially serious when it comes to Medicaid fraud. Individuals and companies can suffer immensely if accused of committing medical fraud. If you or someone you love is under investigation by the Medicaid Fraud Control Unit of the Florida Office of the Attorney general, then it is imperative that you seek out the help of a skilled Florida criminal defense attorney. Don Pumphrey and his legal team at Pumphrey Law Firm have experience representing clients all across the state of Florida, and understand the importance of creating a strong defense for your case. Call (850) 681-7777 or leave an online message today for a free consultation regarding your case.

Written by Karissa Key

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