Insurance Fraud NEWS
Rehab center in Ohio allegedly steals $48M
February 08, 2019, Braking Point, OH
Ryan Sheridan, the former owner of Braking Point Recovery Center, is among six people being federally charged for their roles in a $48 million health care fraud conspiracy, according to the Department of Justice.
He was arrested Thursday afternoon.
Braking Point offered detox, intensive outpatient treatment, day treatment and residential living rehabilitation services for those struggling with drug and alcohol addiction.
The following people were named in the 60-count indictment:
Ryan Sheridan, 38, of Leetonia
Jennifer Sheridan, 40, of Austintown
Kortney Gherardi, 29, of Girard
Lisa Pertee, 50, of Sunbury
Thomas Bailey, 44, of Poland
Arthur Smith, 54, of Austintown
They're all charged with conspiracy to commit health care fraud related to their work at Braking Point Recovery Center.
Investigators said Medicaid was billed $48 million for drug and alcohol recovery services that were not provided, were not medically necessary, lacked proper documentation or had other issues that made them ineligible for reimbursement.
"These defendants are accused of stealing tens of millions of dollars from taxpayers through fraudulent billing and other crimes," said U.S. Attorney Justin Herdman. "These defendants profited off the suffering of others. We will hold accountable anyone who tries to illegally take advantage of the drug epidemic."
Additional charges include health care fraud, money laundering, operating a drug premises, conspiracy to distribute controlled substances and use of a registration number issued to another to obtain controlled substances, among other offenses.
The defendants are accused of using Smith's Drug Enforcement Administration (DEA) data waiver to get over 3,000 doses of Suboxone, a medication used to treat opioid addiction, without Smith having seen patients.
"While the vast majority of the healthcare professionals in this country are committed to saving lives, there are a few who are merely drug dealers hiding in plain view and driven by greed," said DEA Special Agent in Charge Timothy Plancon.
Ryan Sheridan is accused of making numerous financial transactions with money he got from unlawful activities, including health care fraud and conspiracy to commit health care fraud.
Investigators said Bailey dispensed Suboxone when he didn't have the authority to do so.
"These scams are a sucker punch in the face to every family with loved ones struggling with addiction," said Ohio Attorney General Dave Yost. "We will work with our partners to achieve justice -- and get our money back."
Ryan Sheridan also owned and operated other businesses, including Braking Point Health and Fitness LLC and recovery/sober houses.
Between January 2015 and October 2017, investigators said the facility billed Medicaid for drug and alcohol services that:
Were coded to reflect a service more costly than was actually provided
Did not have proper documentation
Did not have proper assessment documentation with valid diagnoses
Were billings for patients that didn't have a diagnosis from a doctor
Were related to treatment at unlicensed in-patient beds
Were for case management services when the clients were working out at Sheridan's gym
Were based on quotas provided to the nurses to bill four to five hours of treatment each day, even if the treatment was not medically necessary
Were for in-patient detox and drug treatment services that were actually provided in an outpatient setting
Between May 2015 and October 2017, investigators said Braking Point submitted about 134,744 claims to Medicaid, totaling over $48.5 million in services.
Medicaid paid Braking Point over $31 million of that, investigators said. Medicaid stopped paying in October of 2017.
In October of 2017, investigators raided the two facilities in Austintown and Whitehall, Ohio, as well as Ryan Sheridan's Leetonia home.
Prosecutors seized $3 million in property in Columbiana, Mahoning and Trumbull counties and eight automobiles, including "Back to the Future," "Ghostbusters" and "Batman" replicas.
Source: WKBN 27