A Miami-Fort Lauderdale pair used a mental health clinic for a $350,000 Medicaid fraud
Finding opportunity in COVID-19 restrictions, a Miami man and a Fort Lauderdale woman used creative billing to turn Zoom mental health therapy sessions into a $350,000 haul from Medicaid.
The fanciful finances by Lorena Osella’s Lighthouse Community Center led to her pleading guilty to one count of conspiracy to commit healthcare fraud. Her partner in white-collar crime, Juan Matos, 59, pleaded guilty to one count of conspiracy to defraud the United States and to pay healthcare kickbacks.
The pair will be sentenced in Fort Lauderdale federal court on Jan. 10, 2022.
Neither of those charges cover Osella’s $18,260 of unemployment fraud to which she admitted with her guilty plea. That’s how much she received from June 2020 through January, while she was paying herself “at least $63,500 from the Lighthouse corporate bank account into her Wells Fargo personal account” as Lighthouse’s sole owner and operator.
State records say Osella, 44, registered Lighthouse Community Center LLC with the state on Jan. 6, 2020. Two months later, the COVID-19 pandemic rewrote the rules of daily life.
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 the activities of daily living or to improve their ability to perform a job while coping with their mental disorder. The mental disorders treated in this manner included, among other things, depression and anxiety.”
Medicaid would pay for an evaluation, treatment plan and 480 hours of PSR services per year.
From May 2020 through January, the PSR services were done via Zoom meetings. Over 98% of Lighthouse’s claims said the Medicaid recipient would receive four hours of counseling four days a week, a total of 16 hours. But witnesses, phone records and Zoom records said most calls, at least 300, were less than two hours long.
“Lighthouse therapists could testify that Osella instructed them to always document “four hours” in the patient notes if four therapy discussion topics were covered even if the PSR services therapy session did not last four hours,” Osella’s admission says. “Therapist M.E.M. advised that Osella instructed her that the patient notes should always be for four hours. M.E.M. would also testify that she never had a therapy session that lasted four hours.”
At least 36.84% of the services billed to Medicaid weren’t 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 per month kickbacks to Medicaid beneficiaries as long as they got PSR services at Lighthouse.
When cops hit Lighthouse with a search warrant on Jan. 14, they found Osella kept solid records, including a 10-page ledger for the kickbacks.
“The ledger contained a list of patients that were receiving kickbacks, which person recruited them, and other information including the date that they started receiving PSR services,” Osella’s admission says. “ln addition, $3,000 in cash was seized in Osella’s purse at the time the warrant was executed.”
This story was originally published November 3, 2021 at 11:46 AM.
