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November 27, 2017 at 09:30 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 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.
