Miami FL area man, woman pull out health care, unemployment fraud
Finding an opportunity under COVID-19 restrictions, a Miami man and Fort Lauderdale woman used creative billing to turn Zoom mental health therapy sessions into $ 350,000 from Medicaid.
The whimsical finances of Lorena Osella’s Lighthouse Community Center led her to plead guilty to one count of conspiracy to commit healthcare fraud. His partner in white-collar crime, Juan Matos, 59, pleaded guilty to one count of conspiring to defraud the United States and pay bribes for health care.
The air will be sentenced in federal court in Fort Lauderdale on January 10, 2022.
Neither charge covers Osella’s $ 18,260 unemployment fraud that she admitted with her guilty plea. This is the amount she received from June 2020 through January, when she transferred “at least $ 63,500 from the Lighthouse Company bank account to her personal Wells Fargo account” as the sole owner and operator of Lighthouse.
State records indicate that Osella, 44, registered Lighthouse Community Center LLC with the state on January 6, 2020. Two months later, the COVID-19 pandemic rewrote the rules of daily living.
Mental health and Medicaid fraud
Lighthouse, 7855 NW 12th St., provided “psychosocial rehabilitation services” (PSR services), described in court documents as “mental health counseling to improve a recipient’s ability to perform activities of daily living or improve their ability to perform work while dealing with their mental disorder. Mental disorders thus treated included, among others, depression and anxiety.
Medicaid would pay for an assessment, a treatment plan, and 480 hours of PSR service per year.
From May 2020 to January, PSR services were performed via Zoom meetings. More than 98% of Lighthouse’s claims said the Medicaid recipient would receive four hours of counseling four days a week, for a total of 16 hours. But witnesses, phone tapes and Zoom tapes said most calls, at least 300, were under two hours.
“Lighthouse therapists could testify that Osella asked them to always document” four hours “in patient notes if four therapy discussion topics were covered even though the PSR services therapy session did not last four. hours, “says Osella’s admission. âThe MEM therapist indicated that Osella told him that the patient’s notes should always be four hours. MEM would also testify that she never had a therapy session that lasted four hours.
At least 36.84% of the services billed to Medicaid were not provided. Lighthouse received $ 950,616 from Medicaid, leaving the fraud amount at $ 350,206.
For such a scam, you need patients. Osella and Matos paid $ 400 a month in bribes to Medicaid recipients as long as they were on PSR services at Lighthouse.
When cops hit Lighthouse with a search warrant on January 14, they discovered Osella was keeping solid records, including a 10-page bribe ledger.
“The registry contained a list of patients who received bribes, who recruited them and other information, including the date they started receiving PSR services,” the admission says. from Osella. “In addition, $ 3,000 in cash was seized from Osella’s purse during the execution of the warrant.”