Jury finds sober home doctor guilty in $31.3M health insurance scam; sentencing set for April – Palm Beach Post

FORT LAUDERDALE — Dr. Mark Agresti, who claimed he devoted his 30-year career to helping people struggling with addiction, on Thursday was convicted of 12 charges of health care fraud for using his clients to perpetuate a $31.3 million insurance scam.

The 59-year-old psychiatrist showed no emotion, but turned briefly and looked at his wife, as U.S. District Judge Rodolfo Ruiz announced the jury’s decision that came after roughly 2 ½ hours of deliberations following a three-week trial.

Agresti, who was once director of psychiatry at the former Columbia Hospital in West Palm Beach, faces a possible decades-long prison sentence after the jury agreed he ordered thousands of medically unnecessary tests when he served as medical director of Good Decisions Sober Living.

Doctor’s defense:‘It blows my mind’: Doctor tells court sober-home owner duped him into $31 million insurance fraud

Owner speaks:“I’m greedy”: Ex-sober home operator remorseless in testifying against doctor

Sentencing scheduled for April 21

The Palm Beach resident is the latest of dozens of people who were prosecuted in connection with Palm Beach County’s once-thriving illicit sober home industry.

While federal prosecutors initially asked that Agresti be taken to jail to await sentencing on April 21, they relented when they learned his father is in a hospice and near death. Ruiz said he didn’t believe Agresti was a flight risk and there was no need to jail him.

Agresti’s defense team, who tried to persuade jurors that Agresti was duped by unscrupulous sober home owner Kenneth Bailynson, said they were disappointed by the verdict.

“We felt that Dr. Agresti was not guilty,” said Richard Lubin, who represented the physician along with attorneys Greg Rosenfeld and Amy Morse. “We will gather to figure out what our next step will be.”

During closing arguments on Thursday, Rosenfeld argued that while Agresti made mistakes, he didn’t commit any crimes.

“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,” he said.

Federal prosecutors countered that Agresti knew exactly what Bailynson was doing, knew it was illegal and helped him anyway.

“They’re asking you to believe the smartest person in the room, a doctor, was tricked,” said Assistant U.S. Attorney James Hayes.

The sober home that Bailynson operated out of a rundown condominium complex on Georgia Avenue in West Palm Beach wasn’t trying to help people beat their addictions, Hayes said.

“It was used as a farm to harvest urine samples and make money off of it,” he said.

The lucrative operation depended on Agresti and his prescription pad. Insurance companies wouldn’t pay for expensive urine tests unless Agresti ordered them.

And Agresti ordered thousands of them during the 23 months he served as medical director of the operation that was shut down in September 2014 after an FBI raid.

Residents were tested at least three times a week. The tests Agresti ordered weren’t simple, inexpensive drug screens that would immediately show whether a resident had relapsed.

Instead, Agresti ordered expensive laboratory tests and asked that each urine sample be screened for as many as 80 different types of drugs.

While insurers would pay about $300 for the quick tests, they would write checks for an average of $1,500 for the more comprehensive screens, Bailynson testified.

Because a lab had to process the complex tests, the results weren’t available for as long as five days. Yet Agresti continued to order additional tests before the results of previous ones were available.

“It makes no sense to order a second test when you haven’t seen the results of the first test, and then order a third test when you haven’t seen the results of either of the other two,” Hayes said.

Doctor said tests deterred drug use. Prosecutors say he never read results.

While testifying in his own defense this week, Agresti said the tests were to serve as a deterrent. Knowing they would be tested regularly, residents were less likely to relapse, he said.

He acknowledged that he didn’t review the test results. That was left to teenage staffers at Good Decisions. Any resident who tested positive was asked to leave.

Again, Hayes said, Agresti’s explanation for ordering the tests and then not reviewing the results defies logic.

“It is unreasonable and makes no sense that a doctor would order the tests and never review the results,” he said.

Rosenfeld insisted that the government’s case was built on the testimony of people who had much to gain by testifying against Agresti.

Bailynson, who pleaded guilty to conspiracy to commit health care fraud, readily admitted to the jury that he was testifying against Agresti in hopes of reducing a promised 10-year prison sentence.

Eric Snyder, owner of the former Real Life Recovery, testified against Agresti, who also served a medical director of the Delray Beach treatment center. Snyder was handed a 10-year prison term in 2019 after pleading guilty to conspiracy to commit wire fraud. He has been allowed to remain free so he can testify against others.

“To believe Dr. Agresti committed fraud, you have to believe a bunch of people who were convicted of fraud,” Rosenfeld told the jury.

Further, he argued that the government cherry-picked patient files and lab tests to cast Agresti in the worst light possible. Also, he said, Agresti had no financial motive to order more tests.

Unlike Bailynson, who pocketed $15 million from the scheme, Agresti was paid a monthly salary. While it increased as the number of residents living at Good Decisions swelled from 25 to nearly 250, it wasn’t based on the number of tests he ordered, Rosenfeld said.

Assistant U.S. Attorney Amanda Perwin said Agresti earned nearly $900,00 while working at Good Decisions and some 10 other sober homes and treatment centers in Palm Beach County.

However, Rosenfeld said, those numbers were inflated. His net income from his work as a medical director at the various locations was $428,000, he said. Of that, about $59,000 came from Good Decisions.

Rosenfeld insisted that Agresti was a compassionate psychiatrist who got caught up in a chaotic situation that spiraled out of control. 

“He told you and he was honest that he was in over his head,” Rosenfeld said. “He told you, ‘I’m an idiot. I didn’t mean to. I wanted to help people.’ ”

Such admissions, particularly for a doctor, are hard to make, he said.

But, Hayes countered, Agresti could have sounded the alarm once he realized Bailynson was using people who were struggling with addiction to get rich.

“The tragedy of this case is Dr. Agresti,” Hayes said. “He had a lot to offer and he didn’t do it.”

jmusgrave@pbpost.com