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Physicians Face 10 Years for $205M Medicare Scam
MIAMI, FL – Two Miami-area doctors were handed 10-year prison sentences for their involvement in a massive Medicare fraud scheme that drained $205 million from the program.
Dr. Mark Willner, 56, and Dr. Alberto Ayala, 68, were sentenced by U.S. District Judge Patricia A. Seitz for their roles in the scam. Both men were found guilty of one count of conspiracy to commit health care fraud in 2012.
The scheme, operated through the mental health care company American Therapeutic Corporation (ATC), involved submitting false and fraudulent claims to Medicare through ATC, which operated purported partial hospitalization programs (PHPs) in seven locations throughout South Florida and Orlando. ATC’s related company, American Sleep Institute (ASI), also submitted fraudulent Medicare claims.
Evidence presented during the trial revealed that 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.
Both Willner and Ayala were ordered to pay significant restitution, with Willner owing more than $57 million and Ayala more than $87 million, both jointly and severally with their co-defendants. They were also sentenced to three years of supervised release following their prison terms.
This is not the first time those involved in the scheme have faced justice. ATC executives Lawrence Duran, Marianella Valera, Judith Negron, and Margarita Acevedo were previously sentenced to prison terms ranging from 91 months to 50 years for their roles in the fraud scheme. Acevedo, who pleaded guilty early on and has been cooperating with the government since November 2010, testified at the doctors’ trial.
The $205 million Medicare scam is one of the largest health care fraud cases in U.S. history. The scheme highlights the need for increased oversight and accountability in the health care industry to prevent such massive fraud schemes from occurring in the future.
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Key Facts
- State: Florida
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release ↗
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