The Miami Herald | EDITORIAL

Stopping Medicare fraud


OUR OPINION: Tougher scrutiny by frontline administrators required

In the latest roundup of accused Medicare fraudsters, Miami is once again one of the main players. Literally. One of the men indicted is local actor Roberto F. Marrero. The TV bit-player ( Miami Vice, America’s Most Wanted — what irony!) and his wife, Sandra Fernandez Viera, are accused of submitting $20 million in false claims to the taxpayer funded federal Medicare program.

Miami has long had the sorry reputation for being the nation’s leader in Medicare fraud, with seemingly just about anybody — from convicted felons to, well, actors — allegedly cashing in on what’s supposed to be a medical safety net for the country’s elderly and disabled. How can this happen? And keep on happening? Where is the federal safety net that weeds out the unqualified or corrupt from getting carte blanche to bilk the American public at a cost of untold millions?

The federal Medicare Fraud Strike Force has been diligently swooping in on fraudsters since 2010, commendably so. But another part of Medicare, the administration arm that certifies that care givers who tap into Medicare reimbursements are actually qualified to do so and then verifies that they actually deliver the services they vouch for, must be much more diligent. Especially so in fraud capitals like Miami where it’s so easy to find an abundance of seniors, some of whom are achingly vulnerable to crooks and cons.

Mr. Marrero and his wife were co-owners of Trust (Trust? Really?) Care Health Services in Miami from 2007 to 2010. The indictment claims that the couple submitted false bills to Medicare to treat 700 homebound diabetic patients who supposedly could not inject their insulin alone and needed the help of expensive, skilled nurses. They are also charged with billing Medicare for physical therapy that wasn’t needed.

The two have also been accused of paying thousands of dollars a month to a recruiter, Enrique Rodriguez, to supply them with patients possessing Medicare cards. Mr. Rodriguez is accused of bribing patients under the indictment.

In all, the indictment snagged 89 people from Miami, Detroit and Los Angeles, who together are charged with cheating Medicare of a total of $223 million. Many of those indicted are healthcare workers — doctors, nurses, clinic operators and therapists.

That’s to be — sad to say — expected. But how does a medical lay person get qualified to deal in Medicare-reimbursed health services?

Mr. Marrero and Ms. Viera are innocent until proven guilty, of course, but their indictment once again raises questions about how well Medicare vets individuals who apply for licenses to dispense healthcare services in this country.

The federal strike force — set up in Miami and eight other regions believed to harbor legions of Medicare con artists — is doing a great job of ferreting out licensed fraudsters. This is the sixth national indictment of major Medicare fraud offenders in the last two years. It’s no easy task, and it takes time and patience to build a credible case.

But this huge problem needs toughening up at the front end in order to stem a growing number of scammers. Much, much more needs to be done to weed out the would-be con artists before they are allowed to set up shop and start pillaging a vital federal healthcare program.

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