Psychiatrist Found Guilty in $110 Million Fraud Scheme

Avery Hurt

February 23, 2022

A Florida jury has found a Palm Beach psychiatrist guilty of one count of conspiracy to commit healthcare fraud and wire fraud and 11 counts of healthcare fraud.

Mark Agresti, MD, 59, was convicted of unlawfully billing approximately $110 million of medically unnecessary urinalysis services for patients living at Good Decisions Sober Living (GDSL), a drug rehabilitation facility in West Palm Beach, Florida. Agresti was once the director of psychiatry at the former Columbia Hospital in West Palm Beach.

According to evidence presented at the trial, Agresti, as medical director of GDSL, agreed to provide standing orders for urinalysis for GDSL patients in exchange for a monthly fee. Three to four times a week, patients were required to submit to excessive and medically unnecessary urine tests, costing $6000 to $9000 per test, according to federal officials. Agresti did not review the results of these tests and did not use the tests to treat patients. The evidence also showed that he had also done this at other addiction facilities in the West Palm Beach area, resulting in thousands of additional fraudulent tests. Agresti had GDSL patients visit his private practice so he could fraudulently bill for services there as well.

"This defendant used his medical license to facilitate an egregious, multimillion-dollar fraud scheme that exploited vulnerable substance abusers," said Juan Antonio Gonzalez, US Attorney for the Southern District of Florida, in a statement announcing the conviction.

Three other defendants, including GDSL's owner, Kenneth Bailynson, were previously indicted and pleaded guilty to related charges connected with the scheme. Agresti, however, insisted on his innocence throughout the trial, arguing that he was himself the victim of Bailynson. Bailynson, as a part of his plea deal, testified against Agresti at the trial.

According to a report in the Palm Beach Post, Agresti's lawyers, in closing statements, argued, "The government did a fantastic job of proving that Dr Agresti was negligent, maybe even grossly negligent, but that's not the issue in this case." The jury disagreed.

Agresti faces a maximum penalty of 20 years in prison for the healthcare fraud and wire fraud conspiracy charges and 10 years for each count of healthcare fraud. Sentencing is scheduled for April 21.

Ten People, Including Two Physicians, Charged in Texas Kickback Scheme

Jose Maldonado, MD, 48, a family medicine physician, and Eduardo Carlos Canova, MD, 44, an internal medicine specialist, both based in Laredo, Texas, were among ten people indicted in connection with a $300 million healthcare fraud scheme

According to the federal indictment, the founders of several lab companies, including Unified Laboratory Services, Spectrum Diagnostic Laboratory, and Reliable Labs, LLC, allegedly paid kickbacks to medical practitioners in exchange for orders for medically unnecessary lab tests, which were then billed to Medicare and other federal healthcare programs. The medical professionals, including Maldonado and Canova, are alleged to have accepted bribes for ordering millions of dollars' worth of tests.

The scheme was facilitated by marketing firms, which paid doctors hundreds of thousands of dollars for "advisory services," according to officials. Rather than providing advice, however, the physicians provided lab test referrals. The labs are accused of paying portions of the salaries of the doctors' staffs as well as portions of their leases. In some instances, direct payments were made to the practitioner's spouse. In one case, the labs informed one practitioner that the payments would cease if he didn't refer more tests. He responded to the threat by immediately increasing his lab referrals, averaging 20 to 30 referrals a day.

Jeffrey Madison, the founder of Spectrum and Unified, is accused of convincing Reliable's founders to convert their business to a physician-owned lab to disguise the kickbacks. Reliable offered physicians ownership opportunities only if they referred enough lab tests. In some cases, says the indictment, the labs made advance payments to physicians to ensure that those physicians would not send samples to other labs.

The scheme resulted in more than $300 million in billing to federal government healthcare programs. Between 2015 and 2018, Maldonado alone received more than $400,000 in kickbacks for ordering more than $4 million worth of lab tests, and Canova received more than $300,000 for ordering more than $12 million in tests, according to the indictment.

The 26-count indictment included charges of conspiracy to commit healthcare fraud, conspiracy to pay and receive healthcare kickbacks, offering or paying illegal kickbacks, and soliciting or receiving illegal kickbacks.

NJ Doc Charged on 34 Counts of Illegal Prescribing Controlled Substances

A NJ orthopedic surgeon has been charged with 34 counts of illegally prescribing controlled substances.

According to documents filed in the case, from November 2016 to February 2018 Evangelos Megariotis, MD, 68, of Passaic County, New Jersey, prescribed opiates — including oxycodone, alprazolam (Xanax), and cough syrup with codeine — as well as stimulants without a legitimate medical purpose and outside the usual course of his practice.

Before the State of New Jersey permanently banned him from practicing medicine, Megariotis owned and operated Clifton Orthopedic Associates, in Clifton, New Jersey.

According to The Bergin Record, the state alleges that Megariotis prescribed thousands of doses of painkillers even though he knew his patients were abusing them and in some cases were getting similar drugs from other doctors. In addition, Megariotis failed to diagnose or treat these patients' underlying conditions, treated illnesses outside his scope of practice, and performed surgery in the absence of medical need.

If convicted, Megariotis could face a lengthy prison sentence as well as substantial fines. The counts of illegally prescribing Schedule II opioids and stimulants are punishable by a maximum of 20 years in prison and a $1 million fine. Illegally prescribing Schedule IV controlled substances brings a maximum of 5 years in prison and a $250,000 fine. The counts of illegally prescribing cough syrup with codeine, a Schedule V controlled substance, are punishable by a maximum of 1 year in prison and a $100,000 fine.

Michigan Surgeon Pleads Guilty to Fraud Scheme

A Bay City, Michigan, vascular surgeon has pleaded guilty to engaging in a scheme to defraud Medicare, Medicaid, and Blue Cross/Blue Shield of Michigan out of approximately $19.5 million

According to the plea agreement, in 2009, Vasso Godiali, MD, 59, began false and fraudulent billing to the three insurers. False claims included billing for the placement of stents in dialysis patients and for the treatment of arterial blood clots. The surgeon admitted to billing for the placement of multiple stents in the same vessel and preparing medical records to support the necessity of placing those stents. However, he never placed the stents.

In the plea document, Godiali also admitted that his medical records would describe occluded arteries that would justify arterial thrombectomies. However, in many cases, there were no occluded arteries, and no thrombectomies were performed, even though Godiali billed insurers for them.

"When Dr Godiali submitted claims for medical services that were never provided, he violated the trust of his patients and defrauded taxpayer-funded health care programs," Mario M. Pinto, Special Agent in Charge, said in a statement announcing the plea.

In 2014, The Bay City Times interviewed Godiali after he was featured by USA Today as one of seven physicians in the United States to receive more than $10 million for Medicare reimbursements in 2012. He told The Times he was a workaholic. "I work a lot — I work probably more than surgeons that you meet," he told the paper.

Godiali faces up to 10 years in prison. In addition, he will be required to pay $19.5 million in restitution to the three insurers. A civil forfeiture case against approximately $39.9 million seized from accounts controlled by Godiali is pending. Sentencing is scheduled for September 15.

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