South Florida Doctor Convicted In $110M Addiction Treatment Fraud Scheme

Miami Herald (FL)

A South Florida doctor faces decades in prison after a federal jury found he unlawfully billed $110 million in drug tests that were deemed medically unnecessary for patients at a sober living facility.

In Feb. 10, Mark Agresti was convicted of one count of conspiracy to commit health care fraud and wire fraud in addition to 11 counts of health care fraud, the U.S. Attorney’s Office of the Southern District of Florida said in a statement.

Agresti is set to be sentenced April 21, facing up to 20 years in prison for the health care fraud and wire fraud conspiracy count, and 10 years for each count of health care fraud, the office said.

This is the second trial conviction that resulted from a Justice Department initiative cracking down on people suspected of exploiting vulnerable patients seeking treatment for drug or alcohol addiction.

As the medical director of Good Decisions Sober Living Inc., a sober home and laboratory in Palm Beach County, Agresti agreed to provide standing orders for urinalysis drug tests for patients in exchange for a monthly fee, the office said.

According to prosecutors, Agresti also had patients from the sober home sent to his medical office so he could fraudulently bill for services for these patients from his own medical practice.

Three or four times per week, patients were “required to submit to excessive, medically unnecessary urine drug tests as a condition of residency,” the office said, adding up to hundreds of drug tests per week and thousands per month.

Each drug test can cost as much as $6,000 to $9,000, the office said, noting that Agresti did not review the drug test results and did not use them to treat the patients.

The fraudulent activity happened from September of 2011 through December of 2015 at the sober home and other addiction treatment facilities in the West Palm Beach area, according to authorities.

“The defendant in this case exploited patients seeking treatment for addiction and pocketed the profits for years,” said in the statement Assistant Director Luis Quesada of the Federal Bureau of Investigation’s Criminal Investigative Division. “This conviction is a warning that fraudulent practices like billing for medically unnecessary services come at a high cost,” he said.

Three other defendants, including the sober home’s owner, Kenneth Bailynson, were previously indicted and pleaded guilty to related charges in connection with this scheme, according to the office. The names of the other defendants are Stephanie Curran and Matthew Noel, a court document shows.

Agresti’s attorneys did not immediately respond to a request for comment.

“The office is closed effective immediately. Patients, please call the office to pick up your medical charts,” the website of Agresti’s medical office says.

In November, Bal Harbour brothers Jonathan and Daniel Markovich were found guilty of swindling $112 million from private insurance companies for addiction treatment services that prosecutors say were either not provided or were unnecessary.

In 2018, the Department of Justice unveiled an array of healthcare fraud cases accusing about 600 defendants nationwide of submitting $2 billion in false bills to the Medicare program for the elderly, the TRICARE system for military members and private insurance companies.

Of that total, about 125 defendants — Agresti included — were charged in South Florida with filing nearly $340 million in fraudulent claims.