Healthcare News & Insights

Two Miami-area doctors receive jail time for Medicare scheme

Two Miami-area doctors and former medical directors at American Therapeutic Corporation (ATC) were each sentenced to 10 years in prison for participating in a $205 million Medicare fraud scheme.

After a seven-week trial, a federal jury in the Southern District of Florida found Dr. Mark Willner, 56, and Dr. Alberto Ayala, 68, each guilty of one count of conspiracy to commit healthcare fraud.

U.S. District Judge Patricia Seitz ordered Dr. Willner to pay more than $57 million in restitution and Dr. Ayala to pay more than $87 million in restitution. In addition, both men were sentenced to three years of supervised release following their prison terms.

According to court documents, Dr. Willner and Dr. Ayala, along with their co-conspirators, caused the submission of false claims through ATC.

What happened?

Evidence at 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.  However, these patients never received the treatments that were billed to Medicare.

For their part in the scheme, Dr. Willner and Dr. Ayala signed patient files without reading them or seeing the patients.  Court documents also revealed that ATC then billed Medicare for more than $100 million in treatment for these patients under the names of the doctors.

Included in these false and fraudulent submissions to Medicare were claims for:

  • patients in neuro-vegetative states
  • patients who were in the late stages of diseases causing permanent cognitive memory loss, and
  • patients who had substance abuse issues and were living in halfway houses.

Co-conspirators

After Medicare paid the claims, some of the co-conspirators laundered that money in order to create cash to pay the patient kickbacks.

ATC executives Lawrence Duran, Marianella Valera, Judith Negron and Margarita Acevedo also 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 are the longest sentences for healthcare fraud to date.

Acevedo, who pleaded guilty early on and has been cooperating with the government, testified at the doctors’ trial.

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