Thieves' Bazaar: Medicare Fraud

Hospitals, doctors and dealers have made Medicare the nation's sweetest crime. The feds are now trying to shutter the door.

Gonzalez paid assisted-living facilities kickbacks to bus in residents suffering from retardation and dementia. The clinics would then bill Medicare for services the "patients" weren't eligible for or didn't receive.

By the time the feds started sniffing around in 2008, Gonzalez had already made off with $28 million, enough to fund a personal fleet of 17 luxury vehicles.

He closed shop in Miami, only to reopen in North Carolina. When he was finally arrested last year, Gonzalez was planning to expand into Tennessee.

Rick Scott: Florida Governor Rick Scott was CEO of a hospital company that was nailed  with two sets of books. Then he went into politics.
photo by Gage Skidmore
Rick Scott: Florida Governor Rick Scott was CEO of a hospital company that was nailed with two sets of books. Then he went into politics.
Miami HEAT taskforce members Christopher Dennis and Reginald France.
Photo by Liliana Mora
Miami HEAT taskforce members Christopher Dennis and Reginald France.

Then there's Armen Kazarian, kingpin of Los Angeles's Armenian mob. The feds say his gang stole the identities of doctors and patients while setting up fake clinics across the country. They knew nothing of medicine, sending Medicare fake bills that showed eye doctors doing bladder tests, obstetricians testing for skin allergies, and dermatologists billing for heart exams.

Medicare paid out $163 million before Kazarian and 73 henchmen were caught by the FBI. His sentence would prove how little risk there was to such grand aspirations. In February, Kazarian received just three years.

Not all schemes are this flamboyant. Some simply employ sleights of paperwork. A Detroit podiatrist billed Medicare $700,000 for performing toenail removals that amounted to little more than toenail clipping. Two Miami doctors billed back rubs as physical therapy, taking in $57 million.

Some are so brazen that they advertise on TV. Remember those late-night Scooter Store ads, promising to get you a motorized wheelchair "at little or no cost to you"?

In 2007, the San Antonio company agreed to pay $4 million in civil fines and forfeit another $43 million for advertising one scooter but delivering a more expensive model on Medicare's dime.

Executives didn't learn their lesson. The Scooter Store was soon caught again, this time for overcharging Medicare by as much as $87.7 million between 2009 and 2011, according to an audit. But CMS agreed to a spectacularly lenient settlement, allowing the company to repay just a quarter of that figure.

The feds would only get tough after CBS aired an investigation illustrating how the company browbeat doctors into writing unnecessary prescriptions for scooters. They raided Scooter Store headquarters in February. It finally appears the company has been barred from federal health programs.

Fraud Blossoms in the Sunshine and Heat

Warm weather attracts mold, mosquitoes and retirees with government benefits. So it's no surprise that Miami is the epicenter of health-care fraud.

It's not just the senior population conveniently warehoused in group homes and assisted-living facilities. There are also large immigrant communities that shield their own, and quick access to countries without extradition treaties.

Then there's the culture of fraud that stinks to the very head of Florida government.

During the 1990s, Republican governor Rick Scott was CEO of the hospital company Columbia/HCA. As the feds later discovered from the largest fraud case in Medicare history, the company seemed more organized-crime outfit than health-care provider.

Columbia billed for tests that weren't necessary or ordered, submitted false diagnoses to increase reimbursements, paid kickbacks to doctors for patient referrals and billed for home visits that people didn't qualify for or receive.

The smoking gun was the two sets of books Columbia kept. One detailed all Medicare submittals. The other noted which were fraudulent, allowing Columbia to keep enough reserves to pay penalties should it ever get caught.

A whistleblower estimated that fraud alone accounted for more than one-third of the company's profits.

When the whip came down in 2003, Columbia settled for $2 billion in fines for "systematically defrauding federal health-care programs." Scott claimed ignorance, though it's hard to believe that a self-described hands-on executive wouldn't know where a third of his company's profits came from.

He was eventually fired — but with the velvet landing accorded to disgraced CEOs. Scott walked away with nearly $10 million in severance, stocks worth $300 million, and a $1 million-a-year consulting contract.

Only two lesser executives got jail time. Lead FBI agent Joe Ford would later regret allowing the company to simply pay away its sins: "People need to go to jail."

Still, fraud knows no party, race or gender. Indeed, the allegations against state Representative Daphne Campbell's (D-Miami) clan could script a health-fraud installment of The Klumps.

Campbell ran ten group homes until the state canceled her Medicaid contract in 2006. Four people died in her facilities that year, including one developmentally disabled female patient who had also been raped. Inspectors found rodent feces and general squalor.

Meanwhile, Campbell's ex-con husband, Hubert Campbell, has been accused by two former partners of defrauding the state's Medicaid program.

Not to be eclipsed, their 28-year-old son, Gregory Campbell, is accused of submitting nearly $300,000 in false Medicare billings while operating adult group homes. He's been charged with felony theft, organized fraud and Medicaid fraud.

But the feds never fully grasped the scope of all this stealing until 2007, when it stumbled upon the novel idea to scrutinize its bills, rather than just paying them.

At the time, the Justice Department was mostly tackling medical-equipment scams involving wheelchairs, hospital beds, respiratory devices and the like.

These were simply schemes. Providers don't need a license, and lax oversight allows them to pop up overnight, bill Medicare for hundreds of thousands of dollars, then disappear just as quickly — only to reemerge elsewhere under a new name.

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8 comments
Currahees3506
Currahees3506

Rick Perry and Sheila Jackson Lee working togetha mayne.

robinvtx
robinvtx

great article. govt never ceases to amaze me.


ElbaTorix
ElbaTorix

Find the blog "Dentist the Menace" and you'll find stuff about Medicaid fraud from corporate dentists. There are dentists who are told by the companies to perform operations on healthy teeth on Medicaid children, as found when a Washington DC TV firm investigated Small Smiles - it probably still happens today right here in Houston

catherinetodd
catherinetodd

Sonja Schoenwald and her cronies are well-experienced in these kinds of matters. Check up wherever she has worked and is working now, in both North and South Carolina. Check court records for her around 1993 on in Durham, NC. 

Sincerely, CatherineTodd

Thomas9
Thomas9 like.author.displayName 1 Like

This shows how our government is so lacked on major multi-million dollar business crimes.  As long as you are a white collar criminal and whatever you are doing does not get major media exposure, you are good. You will not be held accountable for your actions, fines will be minor a best and jail time? forget it, you keep all the money you stole and are allowed to continue to the same time of crime or indulge in others. That is what the US government 'encourages'.  They only go after the blue collar criminal because they are easier and obvious to prosecute. No one in this country, especially the US government will hold themselves accountable for their actions. That includes the lack of action. By the govt. basically slapping people on the wrist to these types of billion dollar crimes, they are encouraging it. Nothing will change until the people take action and 'force' their state and national reps to act. Problem is most of the people across the country don't care, are too lazy and will not do anything about it (i.e. holding themselves accountable for what they should do, act!).

saffie6813
saffie6813 like.author.displayName 1 Like

There is a couple of BILLION in fraud mentioned in just this one article.  Multiply that out everywhere.  If Medicare would just put a billion dollars into the budget for fraud investigation and put these people in jail the plan would be solvent forever.  But even arrest does not deter these crooks because they never see a day in jail and they get to keep most of the money they have stolen.  

One a personal note, I once saw someone at the nursing home measuring everyone for "diabetic shoes"  for which I found they were charging Medicare $420 for each pair.   They looked like sneakers from Walmart to me.  

Unfortunately, we have seen these type of articles before and nothing is ever done.



Thieving_n_Thuggin
Thieving_n_Thuggin

Iffen The Press wants a comment from the loquacious Sistuh Stealing, all they needs is to roll up wid a camera.  She glad to shoot her mouth offen then.

Thieving_n_Thuggin
Thieving_n_Thuggin like.author.displayName 1 Like

It don't be thieving in Sister Stealah Jackson Flea's eyes, it be reparations.

 
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