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National Insurance Crime Bureau

Alleged Fraudsters Charged with Bribing Patients and Fraudulently Billing Medicaid for Psychosocial Rehabilitation Services

Miami, Fl. – A federal grand jury returned an indictment last week charging Miami residents Lorena Osella, 43, and Juan Luis Matos, 58, with running a mental health care fraud scheme that bilked Medicaid out of almost $1 million.

According to the indictment, Osella owned Lighthouse Community Center LLC, a clinic in Doral, Florida that claimed to offer psychosocial rehabilitation (PSR) services,  a type of mental health counseling designed to help people with depression, anxiety, and other  mental disorders cope with their conditions and improve their ability to perform job tasks and daily life activities.  Osella and Matos used bribes to generate business for the clinic, says the indictment:  They offered and paid kickbacks to Medicaid beneficiaries.  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.   

The indictment charges Osella and Matos with conspiring to defraud the United States and to pay health care kickbacks, paying kickbacks in connection with a federal health care program, and theft of government property.  In addition, the indictment charges Osella 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 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.  A federal district judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Acting U.S. Attorney for the Southern District of Florida Juan Antonio Gonzalez and Special Agent in Charge Omar Pérez Aybar, Health and Human Services – Office of Inspector General (HHS-OIG) announced the charges.

HHS-OIG investigated the case. Assistant United States Attorney Timothy Abraham is prosecuting the case.  AUSA Emily Stone is handling asset forfeiture.

An indictment is a charging instrument containing allegations.  A defendant is presumed innocent unless and until proven guilty in a court of law

News article: https://www.justice.gov/usao-sdfl/pr/alleged-fraudsters-charged-bribing-patients-and-fraudulently-billing-medicaid