Dana Group CEO Pleads Guilty to Defrauding Health Care Benefit Programs
TL/DR –
Miguel Saravia, the CEO of Dana Group Associates and former COO of Prime Behavioral Health, has pleaded guilty to six counts of health care fraud for false billing of patient visits. His scheme, which took place from 2017 to 2022, involved directing individuals without medical or billing training to enter false Current Procedural Terminology codes for unprovided therapy services, and also to “upcode” for more expensive treatments than those given. The health care fraud charges carry a sentence of up to 10 years in prison, up to three years of supervised release, and a fine of up to $250,000 or twice the gross gain or loss from the crime.
Former Prime Behavioral Health COO Pleads Guilty to Health Care Fraud
The ex-Chief Operating Officer of Prime Behavioral Health and current CEO of Dana Group Associates, Miguel Saravia, pleaded guilty to six counts of health care fraud. Saravia, based in Hanson, engaged in a scheme to falsely bill health care benefit programs for non-existent patient visits. He has a sentencing date set for Jan. 2, 2025, by U.S. District Court Judge Allison D. Burroughs.
Illegal CPT Coding and Upcoding Fraud
Between 2017 and 2022, Saravia instructed untrained individuals to input Current Procedural Terminology (CPT) codes for services that were not provided. He also directed the upcoding of CPT codes used for psychotherapy sessions. This deceit led to the submission of false claims for treatments that were not rendered, or for treatments more complex and expensive than those administered.
Impending Sentence for Health Care Fraud
Health care fraud charges can lead to a sentence of up to 10 years in prison, up to three years of supervised release, and a fine of up to $250,000, or twice the gross gain or loss from the offense. Federal district court judges impose sentences based on the U.S. Sentencing Guidelines and related statutes.
Joint Announcement by U.S. Officials
The guilty plea was jointly announced by Acting U.S. Attorney Joshua S. Levy, Special Agents in Charge Roberto Coviello of the U.S. Department of Health and Human Services, Office of Inspector General, Jodi Cohen of the Federal Bureau of Investigation, Boston Division, Insurance Fraud Bureau Executive Director Anthony DiPaolo and Harry Chavis, Jr. of the Internal Revenue Service’s Criminal Investigations in Boston. The case is being prosecuted by Assistant U.S. Attorneys Kelly B. Lawrence, Mackenzie A. Queenin, Lindsey Ross and Steven Sharobem.
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