A Miami federal grand jury recently indicted two people on charges they were paying kickbacks to Medicaid beneficiaries to generate business for their mental health counseling clinic in Doral.
According to the indictment, Lorena Osella, 43 owned Lighthouse Community Center, LLC, which purported to offer psychosocial rehabilitation (PSR) services, a type of mental health counseling to help people with depression, anxiety and other mental health issues. It’s alleged that between May 2020 and at least January 2021, she and Juan Luis Matos, 58, paid bribes to register Medicaid beneficiaries as patients to receive PSR services via telemedicine that either were medically unnecessary or that were not billed as provided.
According to the indictment, patients generally received a kickback of $400 in exchange for receiving PSR services. As a result of submitting these fraudulent claims, Medicaid made nearly $1 million in payments to Lighthouse. It’s alleged that Osella and Matos then used the proceeds for their personal benefit.
In addition to fraudulently billing Medicaid, Osella and Matos are charged with illegally receiving Florida unemployment benefits to which they were not entitled.
The indictment charges Osella and Matos with conspiring to defraud the United States and to pay healthcare kickbacks, paying kickbacks in connection with a federal healthcare program, and theft of government property The indictment also charges Osella with conspiring to, and committing, healthcare fraud and wire fraud.
The count charging conspiracy to commit healthcare fraud and wire fraud count is punishable by a maximum potential penalty of 20 years in prison. The counts charging healthcare fraud, anti-kickback violations, and theft of government funds are each punishable by a maximum potential penalty of 10 years in prison. The conspiracy to pay kickbacks is punishable by a maximum potential penalty of five years in prison.
The COVID-19 pandemic has significantly increased the use of telemedicine, serving as a lifeline for many who could not, or did not feel comfortable seeking assistance face-to-face. Couple that with increased demand for mental health counseling and you have a recipe for fraudulent activity.
As we have previously written about, COVID-19-related fraud along with telemedicine-related fraud are two of the top priorities for the government.
Cases such as this one should serve as a reminder that the government is not wavering in its efforts to pursue those engaged in fraud and abuse.
The Health Law Offices of Anthony C. Vitale can assist you should you become the target of a healthcare fraud investigation. For more information contact us at 305-358-4500 or email [email protected]