Two Miami-area doctors, Mark Willner and Alberto Ayala, have been handed down 10-year prison sentences for their roles in a massive $205 million Medicare fraud scheme.
Willner, 56, and Ayala, 68, were medical directors at the mental health care company American Therapeutic Corporation (ATC) when they participated in the scam, which involved submitting false and fraudulent claims to Medicare through ATC’s purported partial hospitalization programs (PHPs) in seven different locations throughout South Florida and Orlando.
The evidence presented during their trial, which began on May 23, 2011, and ended on June 1, 2012, showed that the defendants and their co-conspirators caused the submission of false and fraudulent claims to Medicare, totaling over $205 million.
According to the indictment, ATC secured patients by paying kickbacks to assisted living facility owners and halfway house owners who would then steer patients to ATC. These patients attended ATC, where they were ineligible for the treatment ATC billed to Medicare and where they did not receive the treatment that was billed to Medicare.
After Medicare paid the claims, some of the co-conspirators laundered the Medicare money in order to create cash to pay the patient kickbacks. The defendants were charged in an indictment returned on February 8, 2011, and were found guilty of one count of conspiracy to commit health care fraud.
Willner and Ayala were sentenced by U.S. District Judge Patricia A. Seitz in the Southern District of Florida to pay over $57 million and $87 million in restitution, respectively, both jointly and severally with their co-defendants. They were also sentenced to three years of supervised release following their prison terms.
The case is a stark reminder of the pervasive problem of healthcare fraud in the United States. In a related case, ATC executives Lawrence Duran, Marianella Valera, Judith Negron, and Margarita Acevedo were sentenced to 50 years, 35 years, 35 years, and 91 months in prison, respectively, for their roles in the fraud scheme. The 50- and 35-year sentences represent the longest sentences for healthcare fraud ordered to date.
The investigation was led by the FBI’s Miami Field Office and the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office. The case was prosecuted by the U.S. Attorney’s Office for the Southern District of Florida and the Justice Department’s Criminal Division.
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