Six people indicted for their roles in $48 million health care fraud conspiracy at drug and alcohol

https://www.justice.gov/usao-ndoh/pr/six-people-indicted-their-roles-48-million-health-care-fraud-conspiracy-drug-and

Department of Justice
U.S. Attorney’s Office
Northern District of Ohio

FOR IMMEDIATE RELEASE
Thursday, February 7, 2019

Six people indicted for their roles in $48 million health care fraud conspiracy at drug and alcohol rehabilitation centers in Austintown and Whitehall

Six people from Ohio were indicted in federal court for their roles in a health care fraud conspiracy in which Medicaid was billed $48 million for drug and alcohol recovery services which were not provided, not medically necessary, lacked proper documentation, or had other issues that made them ineligible for reimbursement. Named in the 60-count indictment unsealed in U.S. District Court in Cleveland are: Ryan P. Sheridan, 38, of Leetonia; Jennifer M. Sheridan, 40, of Austintown; Kortney L. Gherardi, 29, of Girard; Lisa M. Pertee, 50, of Sunbury; Thomas Bailey, 44, of Poland, and Arthur H. Smith, 54, of Austintown.

All six are charged with conspiracy to commit health care fraud related to their work at Braking Point Recovery Center, which operated drug and alcohol rehabilitation facilities in Austintown and Whitehall, Ohio.

Additional counts include health care fraud, money laundering, operating a drug premises, conspiracy to distribute controlled substances, use of a registration number issued to another to obtain controlled substances, and other offenses.
(snip)

Ryan Sheridan was the sole owner of Braking Point Recovery Center, which operated drug and alcohol rehabilitation centers in Austintown and Whitehall, Ohio, that provided detox, intensive outpatient treatment, day treatment and residential living rehabilitation. Sheridan also owned and operated numerous other businesses, including Breaking Point Health and Fitness LLC and Braking Point Recovery Housing LLC, which owned recovery houses (or “sober houses”) for individuals attempting to maintain abstinence from drugs and alcohol. As part of being a certified provider, Sheridan agreed to follow the rules and regulations of the Ohio Medicaid Program and the Ohio Department of Mental Health and Addiction Services.

Between January 2015 and October 18, 2017, various defendants submitted or caused to be submitted billings to Medicaid for drug and alcohol services that were: coded to reflect a service more costly than was actually provided; without proper documentation; without proper assessment documents containing valid diagnosis; billings for patients whose records did not contain diagnosis by a physician; related to treatment at unlicensed inpatient beds; billings related to Bailey dispensing of Suboxone even though Bailey did not have the authority to do so; for case management services when, in fact, the clients were working out at Sheridan’s gym; billings based on quotas provided to the nurses by the defendants to bill four to five hours of treatment daily, even if the services were not medically necessary; billing for in-patient detox and drug treatment services that were, in fact, provided in an out-patient setting, among other violations.

Braking Point submitted approximately 134,744 claims to Medicaid for more than $48.5 million in services it claimed to provide between May 2015 and October 2017. The claims caused Medicaid to pay Braking Point more than $31 million. Medicaid suspended payments to Braking Point on October 18, 2017.

The Sheridans, Gherardi, Bailey and Smith are also accused of conspiring to develop a standard protocol of distributing the same amount of Suboxone to every patient seeking drug treatment immediately upon entering Braking Point’s detox program without being evaluated by a properly licensed physician to determine the medical necessity for the use of Suboxone.

The Sheridans, Gherardi and Bailey used Smith’s DEA data waiver license to dispense more than 3,000 doses of Suboxone in 2017 alone without Smith having seen the patients. Smith held himself out to be Braking Point’s medical director but only went to Braking Point approximately twice a month.

Ryan Sheridan is also accused of making numerous financial transactions involving money derived from unlawful activities, including health care fraud and conspiracy to commit health care fraud.
(snip)