WASHINGTON—A federal jury today
convicted two Miami-area doctors, one Miami-area therapist, and two others for
their participation in a Medicare fraud scheme involving more than $205 million
in fraudulent billings by American Therapeutic Corporation (ATC), a mental
health care corporation, the Department of Justice, the FBI, and the Department
of Health and Human Services (HHS) announced today.
Dr. Mark Willner, Dr. Alberto Ayala, and
therapist Vanja Abreu (Ph.D.) were each found guilty of one count of conspiracy
to commit health care fraud. Willner was acquitted of five other counts of
health care fraud and Ayala was acquitted of two other counts of health care
fraud. Hilario Morris and Curtis Gates were each found guilty of one count of
health care kickbacks and were each acquitted of one count of conspiracy.
The jury was unable to reach a unanimous
verdict as to a one conspiracy count against another therapist, Lydia Ward
(Ph.D.). The jury acquitted Nichole Eckert, a licensed mental health counselor
(LMHC), of two counts of health care fraud and was unable to reach a unanimous
verdict as to one conspiracy count against her.
The defendants were charged in an
indictment returned on February 8, 2011. ATC, the management company associated
with ATC, and 14 individuals, including the ATC owners, have all previously
pleaded guilty or have been convicted at trial.
Evidence at trial demonstrated that the
defendants and their co-conspirators caused the submission of false and
fraudulent claims to Medicare through ATC, a Florida corporation headquartered
in Miami that operated purported partial hospitalization programs (PHPs) in
seven different locations throughout South Florida and Orlando. A PHP is a form
of intensive treatment for severe mental illness. The defendants and their
co-conspirators also used a related company, American Sleep Institute (ASI), to
submit fraudulent Medicare claims.
“The doctors, therapist, and patient
recruiters convicted today participated in a massive scheme to defraud the
Medicare program,” said Assistant Attorney General Lanny A. Breuer of the
Justice Department’s Criminal Division. “They altered medical records, robo-signed
patient files, and recruited ineligible patients—all so that they could file
fraudulent claims for reimbursement. We are determined to hold all people—from
well educated professionals to common criminals—accountable for committing
health care fraud.”
“Today’s verdict is a stark reminder
that health care professionals, like any other link in the health care fraud
chain, will be held criminally accountable if they engage in Medicare fraud,”
said U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida. “A
license to practice medicine is not a license to defraud the Medicare program.”
ATC billed Medicare for hundreds of
millions of dollars in false and fictitious services, for thousands of patients
who were not qualified, based on fraudulent documents created by Abreu and
others and bogus certifications signed by Willner and Ayala. In addition, the
evidence at trial showed that Morris paid illegal kickbacks to owners and
operators of assisted living facilities, halfway houses, and to patient brokers
in exchange for delivering ineligible patients to ATC and ASI. Evidence at
trial also showed that Gates solicited and received illegal kickbacks in
exchange for sending ineligible patients to ATC.
Throughout the course of the fraud
conspiracy, tens of millions of dollars in kickbacks were paid in exchange for
Medicare beneficiaries, who did not qualify for PHP services, to attend
treatment programs that were not legitimate PHP programs. ATC and ASI billed
Medicare for more than $205 million in services to patients who did not need
the services and to whom the appropriate services were not provided. According
to the evidence, co-conspirators personally altered, and caused the alteration
of, patient files and therapist notes for the purpose of making it appear,
falsely, that patients being treated by ATC were qualified for PHP treatments
and that the treatments provided were legitimate PHP treatments.
Evidence further revealed that doctors
at ATC, including Willner and Ayala, signed patient files without reading them
or seeing the patients. Specifically, evidence was presented that Willner and
Ayala would “robo-sign” patient files, meaning they would sign patient
documents without having seen or treated the patients. The evidence also showed
that Ayala signed files for services allegedly rendered during time periods
when he was out of the country on vacation. Evidence further revealed that ATC
then billed Medicare for more than $100 million in PHP treatment for these
patients under the names of Willner and Ayala. Included in these false and
fraudulent submissions to Medicare were claims for patients in neuro-vegetative
states, along with patients who were in the late stages of diseases causing
permanent cognitive memory loss—all of whom were ineligible for PHP treatment.
Willner, Ayala, and Morris were remanded
into custody.
ATC executives Lawrence Duran,
Marianella Valera, Judith Negron, and Margarita Acevado were sentenced to 50
years, 35 years, 35 years, and 91 months in prison, respectively, for their roles
in the fraud scheme. Sentencing for Willner, Ayala, Abreu, Morris, and Gates
has not yet been scheduled. The maximum penalty for each conspiracy count and
each count of health care fraud is 10 years in prison. The maximum penalty for
each count of health care kickbacks is five years in prison.
Today’s verdict was announced by
Assistant Attorney General Breuer of the Criminal Division; U.S. Attorney
Ferrer of the Southern District of Florida; John V. Gillies, Special Agent in
Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher
Dennis of the HHS Office of Inspector General (HHS-OIG), Office of
Investigations, Miami Office.
The criminal case is being prosecuted by
Trial Attorneys Jennifer L. Saulino, Robert A. Zink, and James V. Hayes of the
Fraud Section in the Justice Department’s Criminal Division. A related civil
action is being handled by Vanessa I. Reed and Carolyn B. Tapie of the Civil
Division and Assistant U.S. Attorney Ted L. Radway of the Southern District of
Florida. The case was investigated by the FBI and HHS-OIG and was brought as
part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s
Fraud Section and the U.S. Attorney’s Office for the Southern District of
Florida.
Since its inception in March 2007, the
Medicare Fraud Strike Force operations in nine locations have charged more than
1,330 defendants who collectively have billed the Medicare program for more
than $4 billion. In addition, HHS’s Centers for Medicare and Medicaid Services,
working in conjunction with the HHS-OIG, are taking steps to increase
accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care
Fraud Prevention and Enforcement Action Team (HEAT), go to
www.stopmedicarefraud.gov.
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