Drug treatment facility’s CEO accused of submitting fraudulent insurance claims totaling nearly $560,000 [South Florida Sun-Sentinel]

The head of a sober home and drug abuse treatment facility in Palm Beach County is accused of submitting over $500,000 in fraudulent insurance claims, according to court records.

Xiomara Colon, 44, was arrested Thursday on charges of false and fraudulent insurance claims over $100,000, operating a substance abuse facility without a license and unlawful activities relating to personnel, among others, county court records show.

As CEO of Rise to Recovery, a drug treatment facility in West Palm Beach that also ran a sober home in Lake Worth Beach, Colon fraudulently billed three insurance companies for services from June to September 2021, when the facility was not licensed to treat anyone, a probable cause affidavit said.

Substance abuse programs are required by state law to be licensed in order to bill insurance claims. If the companies had known Colon’s facility was not licensed, they would not have paid the claims, the affidavit said.

As the Palm Beach County State Attorney’s Office’s Sober Homes Task Force investigated Rise to Recovery, they learned Colon had also submitted fraudulent documents during the licensure application process and ran the program with unauthorized personnel, the affidavit said.

The Florida Department of Children and Families officials told Colon in June 2021 that Rise to Recovery’s license had expired and that Colon did not apply for renewal in time, the affidavit said.

Colon attempted to apply for another license in late June 2021 since the window had closed for her to apply for renewal, the affidavit said, but DCF denied that application about a month later, in part, because the application included a fraudulent fire inspection report. The report claimed to be completed by an inspector who had retired over a year before the facility submitted the report.

Investigators interviewed two residents who had been in treatment since July and lived at the sober home in Lake Worth Beach in late September 2021, the affidavit said. DCF officials told investigators Rise to Recovery did not disclose running a sober home and that the home was not certified by the necessary state agency, the Florida Association of Recovery Residences.

Both residents told investigators that their therapy sessions were held in the kitchen of the sober home. The woman they had sessions with was not a clinically or medically licensed therapist, the affidavit said, violating the insurance companies’ policies. They said Rise to Recovery staff “pushed massages and chiropractic services on them, even if they didn’t need them,” the affidavit said.

“They stated the chiropractor will do something for a few minutes or less and then bill insurance,” the affidavit said.

A total of $559,219.03 claims were submitted to Blue Cross Blue Shield, Aetna and Optum between June 24, 2021, and Sept. 15, 2021, when Rise to Recovery was not properly licensed, the affidavit said.

Colon’s partner Mark Sanchez, 44, was previously arrested and found guilty of patient brokering related to Rise to Recovery, the affidavit said. Court records show Sanchez was arrested in March 2021 and sentenced to 18 months in state prison. Sanchez will be released in June.

Investigators spoke to Rise to Recovery’s clinical director, who was hired by Sanchez in March 2020, who said she was unaware the facility’s license had expired and was told by Colon that they were operating under a provisional license, the affidavit said. The clinical director was also unaware that her name was used as the referring physician on the insurance claims.

The woman who provided therapy to the sober home residents told investigators she is not a licensed professional but led group and individual sessions, which were billed under the clinical director’s name, the affidavit said.

Colon’s attorney did not respond to an email seeking comment Friday night.

Colon posted bond Friday morning, court records show.

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