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 Feb. 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.