For more than a decade, Medicare crooks have devised a host of scams — and the federal agency that runs the giant healthcare system has fallen for all of them, costing taxpayers billions.
More than 1,600 Medicare offenders have been charged in South Florida federal courts, accounting for one-third of all healthcare fraud cases in the country. Most are common criminals but the list includes a few convicted murderers as well.
The Medicare crime wave began in Miami with the outright theft of Social Security numbers belonging to elderly and disabled beneficiaries. Physicians’ Medicare license numbers also were stolen. Criminals fraudulently used both to bill for all kinds of medical equipment, such as wheelchairs, respirators and nebulizers.
When Medicare regulators finally wised up to that simple scheme, the criminals outfoxed them again. They started working in rings, luring in doctors, recruiters and patients with lucrative kickbacks. Among their rackets: HIV-treatment clinics, physical rehabilitation centers, diabetic homecare operations and mental-health therapy sessions.
Typically, the providers filed false claims for medical services that were not needed or never provided. They collected steady payments from Medicare, which has traditionally paid bills in 14 days.
In many instances, to evade detection the true operators of the crooked businesses registered their Medicare-licensed companies in straw owners’ names, including newly arrived immigrants from Cuba.
In 2010, Congress finally passed a law requiring the fast-paying Medicare bureaucracy to act more like a nimble credit card company to detect fraud. Now, Medicare must use advanced billing software that can flag questionable claims up front to prevent paying them.
The goal is to put an end to the antiquated system of “pay and chase,” with federal authorities chasing after criminals to recover a fraction of the money paid out.
Under the new Affordable Care Act, there are tougher penalties for offenders, expanded administrative powers and $350 million to combat healthcare corruption over the next decade.
Also important: Medicare officials now have the power to suspend payments to providers if there has been a “credible allegation” of fraud, including tips from consumers.