Task force strikes hard at Medicare scams

A joint strike force makes gains against rampant Medicare fraud in Florida.

By Bill Frogameni | Contributor to The Christian Science Monitor

from the March 25, 2008 edition

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Boca Raton, Fla. - Until last May, business was humming at All-Med Billing Corp. Then federal prosecutors charged the Miami-area medical billing company with orchestrating a $101 million scheme to bilk Medicare. Now owners Abner and Mabel Diaz are facing a criminal trial; two of the six other defendants in the case have already pleaded guilty.

Chalk up a victory for the Medicare Fraud Strike Force, a joint experiment of the Federal Bureau of Investigations, the Miami US attorney's office, and Medicare. Relying on traditional investigative methods and heightened interagency cooperation to quickly identify patterns of irregular billing, the one-year-old force charged 197 defendants last year – accounting for about 1 in 4 of all Medicare-fraud defendants in the United States.

"Four years ago, there were maybe one-quarter the number of the cases that we're bringing now" in South Florida, says Alexander Acosta, Miami's US attorney. "Does that mean the fraud wasn't here? No. That just means we weren't looking for the fraud."

Fraud plagues Medicare, the federal program created in 1965 for the elderly and disabled. It's difficult finding a credible estimate to quantify how much is stolen every year, but it likely costs taxpayers billions of dollars. What's clear is that South Florida, with its fast-growing Medicare population, is the country's worst offender in Medicare fraud. This unfortunate distinction prompted the formation of the strike force last March.

Kirk Ogrosky, who manages the strike force in Washington for the Department of Justice, says the concept is being replicated in Los Angeles based on its success in Florida. A Houston strike force is planned to be set up this summer, says Mr. Ogrosky.

All-Med is one of the strike force's biggest cases. Among other things, the Diazes' indictment alleges they helped various Durable Medical Equipment (DME) providers to improperly obtain the Medicare billing numbers of beneficiaries and that those numbers were used for fake charges. The Diazes forged or altered prescriptions to make it appear as if patients needed equipment they did not, according to the indictment. Eventually, Mr. Acosta's office indicted the Diazes for conspiring with 29 DMEs to submit fraudulent claims to Medicare on their behalf.

Billing for unused equipment, drugs

It's a common scam, strike force officials say. Crooked DME operators bill Medicare without providing patients any equipment. In the other common scam, providers bill Medicare for expensive HIV drugs that patients never receive. Instead, they may get a heavily diluted version of the drug or a bag of saline that is supposed to be an HIV infusion.

Another problem is when doctors or patients join the scam. Doctors often write unnecessary prescriptions in exchange for kickbacks from providers (although it's also common for providers to write or alter prescriptions without doctors' knowledge). Patients also may get kickbacks for allowing their Medicare numbers to be used in billing bogus medical goods and services.

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