Health care workers arrested in Miami-Dade Medicaid fraud case

FLORIDA — Attorney General Ashley Moody’s Medicaid Fraud Control Unit has arrested three health care workers from Miami-Dade County for allegedly committing Medicaid fraud.

Dayanais Lopez, 38, Osmany Recano, 45, and Yosvany Rodriguez, 43, are each accused of paying kickbacks to Medicaid recipients for psychosocial rehabilitation services for over two years. The trio reportedly offered recipients up to $500 a month or gift cards redeemable for cash in exchange for attending PSR sessions, resulting in a loss of over $100,000 to the state Medicaid program.

“These health care workers knowingly solicited and discreetly paid kickbacks to Medicaid recipients for mental-health services,” said Moody.

“They were so focused on their criminal agenda that they even instructed changes to insurance providers to allow more claims and told all recipients to keep quiet about the kickbacks.”

Acting on a complaint from Humana, investigators said they found that Cutler Bay Mental Health Corp recruited numerous Medicaid recipients to attend PSR therapies for monetary kickbacks. Lopez and Rodriguez owned and operated the mental health facility, while Recano acted as a driver of the facility and recruited the recipients to attend the sessions, Moody’s office said.

PSR therapies are services to restore a recipient’s skills and abilities necessary for independent living, including food planning and preparation, money management, and more.

The investigation allegedly revealed that recipients reported illegal concerns with the kickbacks to the defendants. However, the defendants reportedly told all recipients to be careful and not to say anything to anyone.

The defendants each face one count of Medicaid fraud, a first-degree felony.

Attorney General Moody’s MFCU will prosecute the case through an agreement with the State Attorney for the 11th Judicial Circuit.