A widening federal investigation into a Miami-based company accused of Medicare fraud netted the arrest of several doctors along with more than a dozen other defendants.

BY JAY WEAVER
February 15, 2011

A trio of doctors altered the diagnoses and medications of thousands of patients to make it look like they qualified for purported group therapy sessions at American Therapeutic’s chain of South Florida clinics, costing the taxpayer-funded Medicare program hundreds of millions of dollars, prosecutors say.

The doctors — Mark Willner, Alan Gumer and Alberto Ayala – were charged along with 17 others Tuesday in the nation’s largest mental healthcare racket, according to the Justice Department.

The charges were the latest in the widening criminal case against Miami-based American Therapeutic, which prosecutors say exploited patients – some suffering dementia and Alzheimer’s disease – who could not possibly benefit from the treatments.

“As today’s charges reflect, defrauding the Medicare system was not an aberration at ATC, but instead part and parcel of its business operations,” said Assistant Attorney General Lanny A. Breuer of the Justice Department’s criminal division. “By exploiting positions of trust, these defendants masked their fraudulent operation as a legitimate mental health business.”

According to the indictment, the three physicians were not only accused of falsifying patient records at American Therapeutic, but also with authorizing psychotherapy without examining patients or their charts, according to an indictment. They also maximized the number of unnecessary treatments for patients to bilk as many as possible from the federal program for the elderly and disabled, the indictment said.

The seven-clinic chain’s program directors – state-licensed mental health counselors Vanja Abreu, Nancy Merced-Sola and Lydia Ward, along with therapist Nichole Eckert – also altered patient files and therapy notes to make it appear that the Medicare beneficiaries actually needed the counseling services, the indictment said.

In October, a Miami federal grand jury indicted American Therapeutic and four senior executives, accusing them of scheming to loot $200 million from the Medicare program by billing the program for purported counseling sessions that were either not necessary or provided. The original criminal case is set for trial in August.

American Therapeutic’s one-time owner, Lawrence Duran, 48, and former chief executive, Marianella Valera, 39, are being detained at the Miami Federal Detention Center, as the FBI and IRS try to account for the $83 million that the notoriously lax Medicare program had paid their company since 2003.

The couple’s detention came after details surfaced on how they and other employees allegedly changed the diagnoses and medications of patients. They would make the changes at “charting parties” to dupe Medicare into believing that the psychotherapy was necessary when, in fact, it wasn’t, Justice Department lawyers say.

According to the initial and latest indictments, Duran and Valera orchestrated a team of ATC marketing employees who paid cash to “patient brokers” who recruited Medicare beneficiaries from dozens of assisted-living facilities and halfway houses across South Florida. Kickbacks were also paid to the residential home operators and sometimes to patients who lived in them.

The case, which is expected to produce more arrests in the coming months, is being handled by the Justice Department, FBI and the Department of Health and Human Services’ Office of Inspector General.