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20 Charged in $200M Medicare Scam

John Commins, for HealthLeaders Media, February 16, 2011

Willner, Gumer and Ayala also allegedly altered diagnoses and medication types and levels to falsely make it appear that the patients qualified for PHP treatments, and manipulated the length of patients' stays in order to maximize the number of days Medicare would pay for the PHP services, prosecutors said.

According to a separate civil complaint, ATC routinely admitted patients to the PHP program who suffered from Alzheimer's and dementia and were ineligible for the PHP program because their mental capacity did not allow them to benefit from group therapy.

The indictments allege that the kickback scheme was supported by a money laundering scheme that issued checks in the names of the defendants or shell corporations they created, cashed the checks and returned the cash to Duran and Valera, who paid the kickbacks. 

In October, the Department of Justice broke up a $200 million Medicare fraud scheme in Miami.

Earlier this month the Office of the Inspector General for the Department of Health and Human Resources posted a list of 'most wanted' Medicare fraudsters.


John Commins is a senior editor with HealthLeaders Media.

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