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$205M Medicare Fraud scheme unravels
A federal jury today convicted two Miami-area doctors, one Miami-area therapist, and two others for their participation in a massive Medicare fraud scheme involving over $205 million in fraudulent billings by American Therapeutic Corporation (ATC), a mental health care corporation, 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-count conspiracy charge 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.”
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.”
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Key Facts
- State: Federal
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release ↗
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