Florida Remains a Hot Bed for Health Care Fraud

Jan 23, 2019

According to a report from the U.S. Department of Health & Human Services’ Office of the Inspector General, Florida was second only to New York for Medicaid fraud recoveries in 2016.

  • florida remains a hot bed for health care fraud
  • florida remains a hot bed for health care fraud
  • florida remains a hot bed for health care fraud

As one of the top states for fraud, Florida remains a hot bed for health care fraud with South Florida leading the region for such cases for the past 20 years. In 2018, Sam Konell, a longtime liaison between mental health clinics and Miami-Dade’s criminal court, was sentenced to 5 years in prison for funneling state-court defendants to a corrupt clinic. This one case cost taxpayers an estimated $25 million. [1]

Due to the tens of millions of dollars in fraud, the Florida chapter of the Citizens Commission on Human Rights (CCHR) is warning lawmakers of the need for an effective system to verify mental health billing validity before heeding calls to funnel more money into a fraudulent system.

“Florida’s well-documented history of health care fraud, including that of mental health, necessitates a better system for detecting and preventing fraud,” said Diane Stein, President of CCHR Florida. “Millions of dollars are stolen from taxpayers and some of our most vulnerable citizens are abused in this epidemic of insurance billing fraud.”

South Florida isn’t the only problem area in the state. Shawn Thorpe, President of Coastal Bay Behavioral Health in Jacksonville, faced charges for $1.4 million in Medicaid fraud in 2017 for a scheme created when he partnered with Ruben McLain, a man who secretly operated under a false name since he was already banned from Medicaid remuneration due to earlier fraud crimes. Thorpe and McLain both plead guilty. [2][3]

Florida’s involuntary examination law is another example of potential fraud given the fact that a person sent for examination, known as a Baker Act, can be held for up to 72 hours before it is determined whether they even met the criteria for incarceration in the first place and the psychiatric facility still bills insurance for the stay. There were more than 199,000 Baker Act initiations in Florida during fiscal year 2016/2017 and with a reported average length of stay at 4.5 days the potential for abusive use and fraudulent billing of Baker Acts is very real.[4][5]

The gray area of what constitutes mental illness and the vulnerability of mental health patients appears to contribute to the ease with which fraud can be committed. As a prime example the manual psychiatrists use, the Diagnostic and Statistical Manual of Mental Disorders, grows every year with new disorders that are largely voted into existence by popular opinion and void of any scientific basis yet these “disorders” all come with an insurance billing code so that the psychiatrist can label a person and get paid for controversial “mental illnesses” such as Caffeine Intoxication Disorder.[6][7]

“Without a better system for detecting psychiatric insurance billing fraud Florida will see the epidemic continue and the taxpayer will foot the bill,” said Stein.

For more information on psychiatric fraud or to report abuse please call CCHR Florida at 727-442-8820 or visit www.cchrflorida.org.

About CCHR: Initially established by the Church of Scientology and renowned psychiatrist Dr. Thomas Szasz in 1969, CCHR’s mission is to eradicate abuses committed under the guise of mental health and enact patient and consumer protections. L. Ron Hubbard, founder of Scientology, first brought psychiatric imprisonment to wide public notice: “Thousands and thousands are seized without process of law, every week, over the ‘free world’ tortured, castrated, killed. All in the name of ‘mental health,’” he wrote in March 1969. For more information visit www.cchrflorida.org


[1] http://www.miamiherald.com/news/local/crime/article201667554.html

[2] http://www.jacksonville.com/news/metro/2017-10-14/pair-faces-fraud-charges-tied-medicaid-payments-jacksonville-mental-health

[3] https://www.cnbc.com/2016/07/22/1-billion-alleged-medicare-fraud-money-laundering-scheme-leads-to-florida-arrests.html

[4] http://www.votersopinion.com/wp-content/uploads/2015/08/Baker-Act-Overview-2013.pdf

[5] http://www.usf.edu/cbcs/baker-act/documents/annual_report.pdf

[6] https://www.cchrint.org/issues/dsm-billing-bible/




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