A ring of Medicare
fraudsters used Miami-Dade courts for years to execute a $63 million health
insurance scam by coordinating with criminal defendants, helping them avoid
incarceration by securing court orders for mental health treatment.
By Samantha Joseph | November 29, 2017 at 04:29 AM
A ring of Medicare fraudsters
used Miami-Dade courts for years to execute a $63 million health insurance
scam, according to information from the U.S. Department of Justice.
The
group coordinated with criminal defendants in the Miami-Dade state court
system, helping them avoid incarceration by securing court orders for mental
health treatment, according to documents filed in federal court. It then
referred the defendants to Greater Miami Behavioral
Healthcare Center Inc., a community mental health center that
has since shuttered.
Greater Miami
Behavioral Healthcare then billed Medicare millions under a partial
hospitalization program that pays for beneficiaries’ outpatient psychiatric
services, despite knowing the patients sometimes didn’t need mental health care
or qualify for the benefit.
The
group submitted more than $63 million in false and fraudulent claims to
Medicare, with one defendant stipulating he generated $9.5-$25 million in false
claims between January 2006 and June 2012.
That man,
70-year-old Samuel Konell of Boca Raton, pleaded guilty
Nov. 21 to one count of conspiracy to defraud the United States and to
receive health care kickbacks.
“In furtherance of
the kickback conspiracy, Konell made representations to judges and others in
the Miami-Dade state court system that the individuals he referred to Greater
Miami received medically necessary PHP services,” according to a DOJ release.
Miami-Dade Circuit
Court spokeswoman Eunice Sigler did not respond to a request for comment by
deadline.
As part of his
guilty plea, Konell admitted to receiving
kickbacks and bribes for referrals for about six years. He said his
co-conspirators and Greater Miami Behavioral Healthcare were careful
to disguise the bribes, and placed him and other patient brokers on the
agency’s payroll. He said the agency paid a flat monthly rate, but offered
bonuses for higher referrals.
The group paid
brokers through shell companies, and solicited patients from
assisted-living facilities, halfway houses and drug courts throughout the
Southern District of Florida. Greater Miami Behavioral Healthcare
disguised the monthly kickbacks as “outreach” or “marketing” payments,
according to the DOJ.
Eleven people,
including seven patient brokers and Greater Miami Behavioral Healthcare principals
and administrators, pleaded guilty to participating in the scheme, according to
the DOJ.
The Federal Bureau
of Investigation’s Miami field office and the Department of Health and Human
Services’ Office of the Inspector General investigated as part of the Medicare
Fraud Strike Force.
Konell’s sentencing
is scheduled for Jan. 30 before U.S. District Judge Jose E. Martinez.
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