Task force strikes hard at Medicare scams

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.

"We arrested eight patients last year – what we call 'professional patients,'" says Tim Delaney, the FBI leader on the Medicare strike force. "They were making a living by renting out their Medicare number and going for treatments they weren't getting." He estimates the phony patients were making "thousands to tens of thousands of dollars" a year.

When the US Department of Health and Human Services last year investigated the three largest South Florida counties – Miami-Dade, Broward, and Palm Beach – it discovered that a quarter of the 1,581 DME providers it visited at random were either not staffed or closed during business hours. An additional 6 percent had no physical facility whatsoever.

Another 2007 health department study concluded that South Florida accounts for 72 percent of all Medicare HIV claims, although only 8 percent of Medicare HIV patients live there.

Fixing South Florida's crisis

Florida's Sen. Mel Martinez (R) recently proposed doubling the maximum jail sentence for Medicare fraud to 10 years and sharply increasing fines. The legislation passed the Senate last month and is currently in committee in the House.

Medicare is moving to tighten its protocols. Last fall, all South Florida DME providers were required to reapply for billing privileges. Medicare has proposed a rule that would require such providers to post a $65,000 bond that they would forfeit in the event of fraud. Medicare will also expand its internal auditing by 2010.

But with 1.2 billion claims to process yearly, the mammoth system is still an easy target, says Kim Brandt, Medicare's director of program integrity. Scammers know that "because there are so many dollars, so many claims getting paid, there's a very good chance they're not going to get caught," she says.

In the last fiscal year, the strike force's civil-law division recovered $50 million in assets from those accused of Medicare fraud – sometimes even before defendants faced criminal charges.

"With this task force, they've decided to do the right thing and go after fraud in a systematic manner. And the results have been spectacular," says Patrick Burns, communications director for the nonprofit group Taxpayers Against Fraud. But given the scope of the problem, much more needs to happen, he says. "We're fishing the ocean with one pole."

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