WASHINGTON—Miami-area residents Dr. Mark
Willner and Dr. Alberto Ayala, former medical directors at the mental health
care company American Therapeutic Corporation (ATC), were each sentenced today
to 10 years in prison for participating in a $205 million Medicare fraud
scheme, announced Assistant Attorney General Lanny A. Breuer of the Justice
Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern
District of Florida; Special Agent in Charge Michael B. Steinbach 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.
Willner, 56, and Ayala, 68, were
sentenced by U.S. District Judge Patricia A. Seitz in the Southern District of
Florida. Judge Seitz ordered Willner to pay more than $57 million in
restitution and Ayala to pay more than $87 million in restitution, both jointly
and severally with their co-defendants. Willner and Ayala were also both
sentenced to three years of supervised release following their prison terms.
On June 1, 2012, after a seven-week
trial, a federal jury in the Southern District of Florida found Willner and
Ayala each guilty of one count of conspiracy to commit health care fraud.
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.
Evidence at trial revealed that ATC
secured patients by paying kickbacks to assisted living facility owners and
halfway house owners who would then steer patients to ATC. These patients
attended ATC, where they were ineligible for the treatment ATC billed to
Medicare and where they did not receive the treatment that was billed to
Medicare. After Medicare paid the claims, some of the co-conspirators then
laundered the Medicare money in order to create cash to pay the patient
kickbacks.
The defendants were charged in an
indictment returned on February 8, 2011. ATC, the management company associated
with ATC, and 20 individuals, including the ATC owners, have all previously
pleaded guilty or have been convicted at trial.
Evidence at trial revealed that doctors
at ATC, including Willner and Ayala, signed patient files without reading them
or seeing the patients. 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 and patients who had substance abuse issues and were living in
halfway houses. These patients were ineligible for PHP treatment, and because
they were forced by their assisted living facility owners and halfway house
owners to attend ATC, they were not receiving treatment for the diseases they
actually had.
Willner and Ayala have been in federal
custody since their convictions.
ATC executives Lawrence Duran,
Marianella Valera, Judith Negron, and Margarita Acevedo were sentenced to 50
years, 35 years, 35 years, and 91 months in prison, respectively, for their
roles in the fraud scheme. The 50- and 35-year sentences represent the longest
sentences for health care fraud ordered to date. Acevedo, who pleaded guilty
early on and has been cooperating with the government since November 2010,
testified at the doctors’ trial.
ATC and Medlink pleaded guilty in May
2011 to conspiracy to commit health care fraud. ATC also pleaded guilty to
conspiracy to defraud the United States and to pay and receive illegal health
care kickbacks. On September 16, 2011, the two corporations were sentenced to
five years of probation per count and ordered to pay restitution of $87
million. Both corporations have been defunct since their owners were arrested
in October 2010.
The case was prosecuted by Trial Attorneys
Jennifer L. Saulino, Robert A. Zink, and James V. Hayes of the Criminal
Division’s Fraud Section. 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, now operating in nine cities across the country,
has charged more than 1,330 defendants who have collectively billed the
Medicare program for more than $4 billion. In addition, HHS’s Centers for
Medicare and Medicaid Services, working in conjunction with HHS-OIG, is 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 Stopmedicarefraud.gov.
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