For one couple, stress took a toll

Retired banker William Sayre tried to tell Medicare it was being cheated. But before the government finally caught up with the scam, taxpayers had lost more than $62,000.

08/03/2008 3:01 AM

09/08/2014 5:34 PM

An artificial leg and leather socket: $4,300.

Ninety pieces of collagen dressing at 48 square inches each: $20,552.

One hundred ninety-two vials of Filgrastim to decrease infection during chemotherapy: $38,112.

Total Medicare bill: $140,382.

But retired banker William Sayre never needed or received any of these supplies or treatments from June 2005 until his death in March 2007. He had two legs, no wounds requiring dressing and no cancer. In fact, the Southwest Miami-Dade man suffered from a heart condition.

And a good chunk of these unnecessary supplies -- and hundreds of others billed in his name -- was paid for by U.S. taxpayers.

MEDICARE NUMBER

All it took to bilk the system was fraudulent South Florida businesses using Sayre's Medicare number along with doctors' personal ID numbers to file false claims.

''He would curse every time he got one of these [Medicare bill] notices in the mail,'' recalled his wife, Marjorie Sayre, 80. 'He would say, `Here I am sick and I have to contend with all this crap.' ''

William Sayre, who died last year at age 76, complained to Medicare and its claims contractors about fraudulent bills submitted under his name and Medicare number by unscrupulous medical equipment providers. A full year passed -- from June 2005 until May 2006 -- before Medicare finally stopped paying the bogus bills submitted by six illegal providers. Total loss to taxpayers: $62,435.

''This is one of the few places in the country where they open businesses solely for the purpose of defrauding Medicare,'' said Timothy Delaney, assistant special agent in charge of the FBI in Miami.

For elderly patients like William Sayre, being on the receiving end of that fraud fueled his anxiety, stress and frustration. His blood pressure would spike every time he got his quarterly summary notices of Medicare bills in the mail, because he was responsible for a 20 percent copayment, his wife said.

LARGE BILL

Consider his June 2005 summary for the improbably large collagen dressing order: It showed the government program approved $17,127 of the $20,552 bill.

It indicated that Medicare paid $13,701 to the provider, RC Medical Equipment and Services, of Hallandale Beach. But the notice also said Sayre might be billed for the balance, $3,425.

Fortunately, he never got stuck with it, his wife said.

But her husband could never understand why Medicare didn't just cancel his number when he exposed the fraud.

She said he called the banks and credit card companies about his stolen Medicare number, which is the same as his Social Security number. They were on alert right away, she said.

But Medicare -- a bureaucracy created by Congress in 1965 with a mandate to pay claims first and verify them later -- doesn't have the authority to cancel a patient's stolen number.

Sayre's Medicare number was used by a half-dozen South Florida companies that billed the government program for fraudulent equipment claims, according to the FBI.

Agents eventually caught up with three of their owners, though the charges stemmed from unrelated phony claims filed under other Medicare patients' names.

One convicted supplier, Reddy Cabrera, of Hialeah, submitted $13 million in Medicare claims through his company, RC Medical Equipment & Services, Inc., of Hallandale Beach.

Medicare denied the majority of those claims but still paid Cabrera's company about $2.5 million in 2005. None of the money was recovered. Cabrera, 25, was sentenced to two years in prison.

Another convicted supplier, Virgilio Miranda, 55, co-owner of AID Medical Equipment and Progressive Services, of Miami, submitted about $3 million in false Medicare claims.

He and other business partners were paid more than $2.6 million. Miranda is serving four years in prison.

Yet another suspect, Madelin Barbara Machado, owner of Zigma Medical Care in Miami, is a fugitive -- having possibly fled to Cuba, according to the FBI.

The 34-year-old Hialeah woman was charged in January with filing $9.3 million in bogus bills to Medicare, court records show. Her company received $4.5 million. None was recovered.

Said Marjorie Sayre: ``I hope they take these people and throw them in jail and make them pay all the money back.''

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