MEDICARE FRAUD

Stealing Medicare blind, at a cost of billions

 

The Federal Bureau of Investigation has been tracking at least 90 fugitives who have ripped off hundreds of millions of dollars from the U.S. government while filing billions in bogus Medicare claims. The pace of arrests has picked up in the last year but about two-thirds remain at large, many of them fleeing back home to Cuba.


jweaver@MiamiHerald.com

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.

Read more Miami-Dade stories from the Miami Herald

Miami Herald

Join the
Discussion

The Miami Herald is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere on the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from profanity, hate speech, personal comments and remarks that are off point. Thank you for taking the time to offer your thoughts.

The Miami Herald uses Facebook's commenting system. You need to log in with a Facebook account in order to comment. If you have questions about commenting with your Facebook account, click here.

Have a news tip? You can send it anonymously. Click here to send us your tip - or - consider joining the Public Insight Network and become a source for The Miami Herald and el Nuevo Herald.

Hide Comments

This affects comments on all stories.

Cancel OK

  • Marketplace

Today's Circulars

  • Quick Job Search

Enter Keyword(s) Enter City Select a State Select a Category