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Thursday, September 19, 2024 88° Today's Paper



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Top News


89 CHARGED IN MEDICARE FRAUD BUSTS IN 8 CITIES

By Kelli Kennedy & Pete Yost

May 14, 2013

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WASHINGTON » Nearly 100 people, including 14 doctors and nurses, were charged
for their roles in separate Medicare scams that collectively billed the
taxpayer-funded program for roughly $223 million in bogus charges in a massive
bust spanning eight cities, federal authorities said today.

It was the latest in a string of similar announcements by Health and Human
Services Secretary Kathleen Sebelius and Attorney General Eric Holder as federal
authorities crack down on fraud that’s believed to cost the program between $60
billion and $90 billion each year. Stopping Medicare’s budget from hemorrhaging
that money will be key to paying for President Barack Obama’s health care
overhaul. Sebelius and Holder partnered in 2009 to increase enforcement by
allocating more money and staff and creating strike forces in fraud hot spots
around the country.

Miami, long known as ground zero for the complex scams, was again at the center
of today’s busts with 25 people charged for their role in various schemes.
Authorities allege five defendants in one scheme bribed Medicare patients for
their ID numbers, allowing them to bill for $51 million in home health services
that were never given or were not medically necessary.

Nearly 20 people, including two doctors, a physician’s assistant and two
therapists, were charged in various scams in Detroit. In one case, three posed
as licensed physicians and wrote bogus prescriptions for drugs and psychotherapy
services totaling $12 million, the Health and Human Services and Justice
departments said in a statement.

In Los Angeles, 13 people were charged in various scams totaling $23 million. In
one case, authorities said three people hired workers to recruit Medicare
patients. Once the defendants received the patient’s Medicare ID numbers, they
worked with doctors and medical clinics to get prescriptions for power
wheelchairs, which they sold for kickbacks, authorities said in a statement.

Roughly 400 agents fanned out across the country as part of today’s arrests
raiding businesses, seizing documents and charging 89 suspects in Miami, Los
Angeles, Houston, Brooklyn, Detroit, Chicago, Tampa, Fla., and Baton Rouge, La.

Four doctors were charged in various scams in Chicago and Brooklyn.

Sebelius hailed the Affordable Care Act as one of the best tools we have to
“preserve Medicare and protect the tens of millions of Americans who rely on it
each day.”

The law makes it harder for criminals to submit fraudulent Medicare claims and
allows the government to suspend payments once they’re caught.

Medicare fraud has adapted into complex schemes over the years, moving from
medical equipment and HIV infusion fraud to ambulance scams, as crooks try to
stay one step ahead of authorities. The scams have also grown more sophisticated
using recruiters who are paid kickbacks for finding patients, while doctors,
nurses and company owners coordinate to appear to deliver medical services that
they are not.

For decades, Medicare has operated under a pay-and-chase system, paying
providers first and investigating suspicious claims later. The system worked
when the agency was paying hospitals and institutions that couldn’t close up
shop and flee the country if they’d been overpaid. Federal authorities are using
new technology designed to flag suspicious claims before they are paid, but the
system is still in its infancy.

Today’s bust marks the sixth national Medicare fraud takedown under the strike
force teams. Nearly 600 individuals have been charged in schemes involving
almost $2 billion, the Health and Human Services and Justice department said.

“Taxpayers expect us to work harder and smarter, and that is exactly what
happened across the nation today,” said Health and Human Services inspector
general Daniel R. Levinson.

Kennedy reported from Miami.

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