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Life Health > Health Insurance > Health Insurance

Medicare Scammers Defrauded Miami-Dade Courts: DOJ

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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 million to $25 million in false claims between January 2006 and June 2012.

(Related: 7 Things Trump’s New DOL Pick Knows About Benefits)

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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