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$205 Million Medicare Fraud Scheme Earns Two Miami Doctors 10 Years in Prison

Dr. Mark Willner and Dr. Alberto Ayala, both former medical directors of Miami-based mental healthcare company American Therapeutic Corporation (ATC), have each been sentenced to 10 years in prison for their role in a $205 million Medicare fraud scheme. In addition, Dr. Willner must pay over $57 million in restitution, and Dr. Ayala must pay over $87 million in restitution, jointly and severally with their co-defendants. Following their prison terms, Dr. Willner and Dr. Ayala are to serve three years of supervised release.

Doctors Billed Medicare for Treatment They Did Not Provide to Medicare Beneficiaries

 

A federal jury found Drs. Willner and Ayala guilty of conspiracy to commit healthcare fraud following a seven week trial earlier this year, according to the Justice Department. At trial, prosecutors proved that Drs. Willner and Ayala, along with their co-conspirators, used ATC to file fraudulent claims with the Medicare program for purported partial hospitalization program (PHP) treatment through facilities located throughout South Florida and Orlando. PHP involves intensive treatment for patients with severe mental illness.

ATC obtained personal information about Medicare beneficiaries by paying kickbacks to the owners of assisted living facilities and halfway houses who steered patients to ATC. Although these patients were ineligible for PHP and did not actually receive treatment, ATC billed Medicare for PHP treatment that it purportedly provided to them. When the conspiracy was uncovered, federal prosecutors charged ATC, its management company, and 20 individuals, including the owners of ATC. All of these defendants have pleaded guilty or been convicted at trial.

Prosecutors proved that ATC doctors, including Drs. Willner and Ayala, signed patient files without reviewing them or visiting the patients. ATC then billed Medicare over $100 million in the names of Drs. Willner and Ayala for PHP treatment that the company purportedly provided to these patients. ATC billed Medicare for treatment of patients who were in neuro-vegetative states, who had permanent cognitive memory loss, and who suffered from substance abuse. None of these patients were eligible for PHP treatment, and because the owners of halfway houses and assisted-living facilities where they lived pushed them to ATC, they did not receive treatment that might actually have helped them.

Two ATC executives — Lawrence Duran and Marianella Valera — received sentences of 50 and 35 years for their part in the Medicare fraud scheme. These sentences were the longest ever given for healthcare fraud.

Whistleblowers Can Help Authorities Stop Medicare Fraud Before Costs Soar

 

Whistleblowers provide valuable help to federal prosecutors when they share evidence of Medicare fraud. Because their help is so important, the qui tam provisions of the False Claims Act allow whistleblowers to file suit on behalf of the federal government and to receive a portion of any funds recovered in the lawsuit.

The attorneys at Waters & Kraus have extensive experience representing whistleblowers in a variety of fraud cases. Contact us or call our whistleblower attorneys at 800.226.9880 to learn more about our practice and how we can assist.

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