South Florida has gained the unwelcome reputation of being a hotbed for Medicare fraud. The recent conviction of two doctors, a therapist, and two other individuals from the Miami area for involvement in a $205 million Medicare fraud scheme has not helped that reputation. Drs. Alberto Ayala along with Mark Willner and therapist Dr. Vanja Abreu were convicted by a federal jury of conspiracy to commit health care fraud through two Miami-area health care providers.
Prosecutors showed that the trial defendants, along with several co-conspirators, caused false claims to be submitted to Medicare through American Therapeutic Corporation (ATC) and American Sleep Institute (ASI). The co-conspirators prescribed inappropriate treatment for patients, recruited ineligible patients, altered patient records, and robo-signed patient files without seeing or treating the patients — all to support Medicare claims that were fraudulent including the following.
- Prescribing treatment for which the patients were ineligible under Medicare guidelines.
- Prescribing inappropriate treatment programs.
- Not providing the appropriate services as they were prescribed.
According to the Justice Department, prosecutors had already secured convictions or guilty pleas before trial from ATC, its management company, the owners of ATC, and several other individuals involved in the fraud. Three of ATC’s former executives have received very substantial prison sentences of 35 to 50 years. The trial defendants have not yet been sentenced, however.
Waters & Kraus is a national firm with highly skilled lawyers practicing qui tam litigation in four offices, including Dallas, Los Angeles, San Francisco, and Baltimore. Our attorneys have decades of experience successfully representing whistleblowers in a variety of fraud cases. Contact us or call our attorneys at 800.226.9880 to learn more about our practice and how we can assist.