Miami Duo Charged With Bilking Nearly $1 Million From Medicaid


In last week’s blog, we reported on a settlement the University of Miami had made. We noted that UM had agreed to pay $22 million to settle claims that it was involved in medically unnecessary laboratory tests and fraudulent billing practices. The university allegedly engaged in three practices that violated the False Claims Act.


Unfortunately for the world famous Florida city, Miami could not stay out of the health care fraud news in the past week. As reported by the Southern District of Florida branch of the United States Department of Justice this week, two Miami-based fraudsters have been brought up on charges.


The Miami duo bilked almost $1 million out of Medicaid.

43 year-old Lorena Osella and 58 year-old Juan Luis Matos where indicted by a federal grand jury for bribing patients and fraudulently billing Medicaid for psychosocial rehabilitation services. By conducting this mental health care fraud scheme, the pair ended up bilking Medicaid out of nearly $1 million.


As the DoJ reports, Osella owned Lighthouse Community Center LLC. The Doral, Florida-based clinic claimed to offer psychosocial rehabilitation (PSR) services. This is a type of mental health counseling that is designed to help people with depression, anxiety and other mental disorders. The objective of treatments is to help sufferers of these conditions to improve their ability to perform job tasks and daily life activities.


Osella and Matos used bribes to generate business for the clinic.


“They offered and paid kickbacks to Medicaid beneficiaries,” reveals the DoJ, “ In exchange, the beneficiaries registered as patients with the clinic and agreed to receive PSR services via telemedicine that they either did not need or that were not billed as provided. During the time they fraudulently billed Medicaid, Osella and Matos are charged with illegally receiving Florida unemployment benefits as well.”


In addition, the indictment charges Osella and Matos with conspiring to defraud the United States. They are also charged with paying health care kickbacks, paying kickbacks in connection with a federal health care program and theft of government property. The charges don’t end there. Osella is also charged with conspiring to, and committing, health care fraud and wire fraud.


“The count charging conspiracy to commit health care fraud and wire fraud count is punishable by a maximum potential penalty of 20 years in prison,” the DoJ reports, “The counts charging health care fraud, anti-kickback violations, and theft of government funds are each punishable by a maximum potential penalty of 10 years in prison. Finally, the conspiracy to pay kickbacks is punishable by a maximum potential penalty of five years in prison.”


Are you an attorney who is currently working a health care fraud case?


The clinical experts at Allegiant Experts can help you! Everything our team does focuses on inclusive, comprehensive and cost-effective health care. Among our many services, we coordinate and support courageous whistleblowers who shine lights on fraud, waste and abuse. Contact us today to schedule a complimentary consultation. Please don’t hesitate to give us a call at 407-217-5831. You may also email us at info@allegiantexperts.com.

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