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WASHINGTON—Miami-area residents Dr. MarkWillner and Dr. Alberto Ayala, former medical directors at the mental healthcare company American Therapeutic Corporation (ATC), were each sentenced todayto 10 years in prison for participating in a $205 million Medicare fraudscheme, announced Assistant Attorney General Lanny A. Breuer of the JusticeDepartment’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the SouthernDistrict of Florida; Special Agent in Charge Michael B. Steinbach of the FBI’sMiami Field Office; and Special Agent in Charge Christopher Dennis of theHHS-Office of Inspector General (HHS-OIG), Office of Investigations MiamiOffice.
Willner, 56, and Ayala, 68, weresentenced by U.S. District Judge Patricia A. Seitz in the Southern District ofFlorida. Judge Seitz ordered Willner to pay more than $57 million inrestitution and Ayala to pay more than $87 million in restitution, both jointlyand severally with their co-defendants. Willner and Ayala were also bothsentenced to three years of supervised release following their prison terms.
On June 1, 2012, after a seven-weektrial, a federal jury in the Southern District of Florida found Willner andAyala each guilty of one count of conspiracy to commit health care fraud.
Evidence at trial demonstrated that thedefendants and their co-conspirators caused the submission of false andfraudulent claims to Medicare through ATC, a Florida corporation headquarteredin Miami that operated purported partial hospitalization programs (PHPs) inseven different locations throughout South Florida and Orlando. A PHP is a formof intensive treatment for severe mental illness. The defendants and theirco-conspirators also used a related company, American Sleep Institute (ASI), tosubmit fraudulent Medicare claims.
Evidence at trial revealed that ATCsecured patients by paying kickbacks to assisted living facility owners andhalfway house owners who would then steer patients to ATC. These patientsattended ATC, where they were ineligible for the treatment ATC billed toMedicare and where they did not receive the treatment that was billed toMedicare. After Medicare paid the claims, some of the co-conspirators thenlaundered the Medicare money in order to create cash to pay the patientkickbacks.
The defendants were charged in anindictment returned on February 8, 2011. ATC, the management company associatedwith ATC, and 20 individuals, including the ATC owners, have all previouslypleaded guilty or have been convicted at trial.
Evidence at trial revealed that doctorsat ATC, including Willner and Ayala, signed patient files without reading themor seeing the patients. Evidence further revealed that ATC then billed Medicarefor more than $100 million in PHP treatment for these patients under the namesof Willner and Ayala. Included in these false and fraudulent submissions toMedicare were claims for patients in neuro-vegetative states, along withpatients who were in the late stages of diseases causing permanent cognitivememory loss and patients who had substance abuse issues and were living inhalfway houses. These patients were ineligible for PHP treatment, and becausethey were forced by their assisted living facility owners and halfway houseowners to attend ATC, they were not receiving treatment for the diseases theyactually had.
Willner and Ayala have been in federalcustody since their convictions.
ATC executives Lawrence Duran,Marianella Valera, Judith Negron, and Margarita Acevedo were sentenced to 50years, 35 years, 35 years, and 91 months in prison, respectively, for theirroles in the fraud scheme. The 50- and 35-year sentences represent the longestsentences for health care fraud ordered to date. Acevedo, who pleaded guiltyearly on and has been cooperating with the government since November 2010,testified at the doctors’ trial.
ATC and Medlink pleaded guilty in May2011 to conspiracy to commit health care fraud. ATC also pleaded guilty toconspiracy to defraud the United States and to pay and receive illegal healthcare kickbacks. On September 16, 2011, the two corporations were sentenced tofive years of probation per count and ordered to pay restitution of $87million. Both corporations have been defunct since their owners were arrestedin October 2010.
The case was prosecuted by Trial AttorneysJennifer L. Saulino, Robert A. Zink, and James V. Hayes of the CriminalDivision’s Fraud Section. The case was investigated by the FBI and HHS-OIG andwas brought as part of the Medicare Fraud Strike Force, supervised by theCriminal Division’s Fraud Section and the U.S. Attorney’s Office for theSouthern District of Florida.
Since its inception in March 2007, theMedicare Fraud Strike Force, now operating in nine cities across the country,has charged more than 1,330 defendants who have collectively billed theMedicare program for more than $4 billion. In addition, HHS’s Centers forMedicare and Medicaid Services, working in conjunction with HHS-OIG, is takingsteps to increase accountability and decrease the presence of fraudulentproviders.
To learn more about the Health CareFraud Prevention and Enforcement Action Team (HEAT), go to Stopmedicarefraud.gov.
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