Fanciful Finances

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Close-up Of A Doctor's Hand Analyzing Report On White Desk

COVID-19 has brought out the best and the worst in people. While many Americans have helped each other overcome seemingly insurmountable challenges during the pandemic, a Ft. Lauderdale-Miami pair helped themselves to $350,000 through a mental health clinic healthcare scheme that used creative billing practices and online therapy sessions.

Lorena Osella, 44, of Ft. Lauderdale, registered Lighthouse Community Center LLC with the State of Florida just a few months before COVID-19 hit. The mental health facility provided psychosocial rehabilitation services (PSR) or mental health counseling that could help with an individual’s ability to perform activities of daily living or perform a job while learning to cope with their mental disorder, which in many cases included anxiety and depression. (Medicaid allowed these services to be provided online to accommodate beneficiaries during the pandemic.)

Medicaid covered costs for an evaluation, treatment plan and 480 hours of PSR services each year. Between May 2020 and January 2021, the PSR services were provided by Lighthouse via Zoom meetings.

About 98% of the claims that Osella submitted for Lighthouse stated that the Medicaid beneficiaries served at her practice received four hours of counseling four days a week, for a total of 16 hours. However, witnesses, phone records and Zoom records documented at least 300 calls at less than two hours long each. (Therapists also testified that Osella instructed them to always document four hours in the patient notes, even if the session did not last that long. In fact, one therapist said the sessions never lasted that long.) 

Court documents showed that at least 36.84% of the services billed to Medicaid were not provided, but Lighthouse received $950,616 from the government healthcare program as if they had been provided. (That’s some fanciful finances for sure.) The total loss to Medicaid was $350,206.

To carry out such a healthcare scam as large as this one, Osella needed a little help in obtaining patients. Her partner in crime was Juan Matos, 59, of Miami. Together, the fraud duo lined up patients for their mental health practice by paying out $400 per month in kickbacks for those who signed up for PSR services at Lighthouse.

When a search warrant was executed, they discovered that Osella kept great records. A 10-page ledger contained a list of patients who had received kickbacks. The document also showed who recruited them, and the date they started receiving PSR services. Investigators also seized $3,000 in cash that was found in Osella’s purse.

You might find it interesting to know that Osella also pleaded guilty to unemployment fraud for receiving $18,260 at the same time she was also paying herself at least $63,500 from her company’s corporate bank account.

Osella pleaded guilty to one count of conspiracy to commit healthcare fraud. Matos pleaded guilty to one count of conspiracy to defraud the United States and to pay healthcare kickbacks. The deceptive duo will be sentenced in Fort Lauderdale federal court on Jan. 10, 2022.

Today’s Fraud of the Day comes from an article, “A Miami-Fort Lauderdale pair used a mental health clinic for a $350,000 Medicaid fraud,” dated September 21, 2021.

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.

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Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.