Ironic

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36419238 - judge about to bang gavel on sounding block in the court room

When mentally ill individuals commit a crime, it’s often difficult to decide on the appropriate punishment, whether that includes treatment in a partial hospitalization program (PHP) or incarceration. Today’s fraudster, a man who worked on behalf of hundreds of mentally ill defendants to lobby judges for PHP treatments, ironically found himself in front of a judge at the same Miami courthouse where he visited defendants on a regular basis. This time, he pleaded guilty to Medicare fraud for using his influence to obtain government sponsored PHP treatments for inmates, stealing $63 million from Medicare.

The man at the center of today’s article was considered an asset to judges in the Miami courthouse for managing the problems of the mentally ill residing in jails. However, the reality is that he was a patient broker. It was his job to refer mentally ill defendants to a treatment program at a Miami community medical center to keep them out of jail. The corrupt city clinic put today’s fraudster on their payroll to conceal the illegal kickbacks, making it look like he was earning a salary. (Just so you know, patient brokering is illegal and is a form of human trafficking.) The clinic also paid him holiday bonuses when he exceeded his quota for patient referrals. (He received an extra $432,829 over six years, in addition to his regular salary.) And, the clinic submitted bogus claims worth $63 million to Medicare in total. (Clients that were referred to the clinic cost taxpayers between $9.5 million and $25 million in bogus claims over six years.)

Apparently, during the 70-year-old man’s trial, he had the support of some very prestigious people including two defense lawyers, a former Miami-Dade assistant public defender and a sitting Miami-Dade judge. The defense attorney tried to paint a picture of a former drug addict who had reformed his life, accomplishing many things including counseling traumatized Vietnam veterans, managing services for assisted living facilities and creating day therapy programs across Miami-Dade County. (But despite the glowing references and a long list of great things he had done, the judge didn’t buy it.)

 The patient broker pleaded guilty to Medicare fraud for receiving healthcare kickbacks. He admitted that he obtained court orders for mental health treatment instead of incarceration so he could refer the defendants to the clinic in return for kickbacks. (Apparently, he knew that some of the Medicare beneficiaries he referred for PHP treatment were not mentally ill or did not meet the requirements for PHP treatment.)

 

He was sentenced to five years in prison to be followed by three years of supervised release and must pay $9.9 million in restitution. (The judge told him it would take more than 700 years to pay his debt back.) He also forfeited other assets including several pieces of jewelry to lower the amount due.

It is estimated that 58 percent of the Miami-Dade County criminal-court defendants have a mental illness. (And patient brokers, like today’s fraudster, went from cell to cell signing up vulnerable inmates for the bogus PHP program.) The claims were fake because the services billed for were medically unnecessary and were never eligible for Medicare reimbursement or provided by the corrupt clinic. Congratulations to the Medicare Strike force for convicting a total of 11 people who were involved in this ironic, fraudulent scheme.

Today’s “Fraud of the Day” is based on an article entitled, “He devoted career to helping mentally ill defendants. Now, he’s going to prison for fraud.” published by the Miami Herald on February 23, 2018.

A former drug addict who reformed his life, Sam Konell became a fixture at Miami’s criminal courthouse for decades, lobbying judges to get treatment for mentally ill defendants — and to keep them out of jail.

So it was with tragic irony that Konell on Thursday found himself before a judge yet again. This time, he was convicted of illegally steering state-court defendants to a corrupt clinic, which in turned fraudulently billed Medicare for more than $63 million.

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Larry Benson
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.