Eye on 'professional patients'

Editor's note: Story originally published Oct. 21, 2004. Corrections appended.

Targeting 1,500 "professional patients" in Miami-Dade who run up huge Medicare bills, federal officials say they began denying payments to their providers in June, saving taxpayers $4.2 million a week in fraudulent claims. The move is part of a widespread effort to change the status of South Florida as "the healthcare-fraud capital of the world, " Marcos Daniel Jiménez, the U.S. attorney in Miami, said this week in an interview with The Herald.

Last year, federal prosecutors indicted 139 people in South Florida for healthcare fraud - almost triple the number the year before. "I think we easily double the number of healthcare cases as the next highest district, " Jiménez said. Those indicted are accused of falsely billing Medicare, mostly for such expensive medical devices as artificial limbs and wheelchairs. Patients are rarely arrested, but this summer officials began rejecting high bills for nonemergency care from 500 select patients whose medical experiences were apparently far above average. Some of these patients had run up $30,000 in device-related expenses in a matter of days. Said Teresa Wilson, a Medicare administrator in Miami: "Investigators visiting their homes . . . saw things like six prosthetic limbs for a single individual who had all [his] limbs intact or people who were receiving wheelchairs and . . . the [wheelchairs were] boxed for delivery outside the country." Medicare believes it is saving about $250 million a year through the project - which is serving as a pilot for the rest of the country. Few of the targeted patients have complained, just 400, so far, from among the 1,500, Wilson said. Officials say they don't know why so much healthcare fraud occurs here, except for the region's long history of sleazy dealings, starting with the selling of swamp land and extending through the wide-open casinos of the 1930s and '40s and the cocaine cowboys of the '80s. Fraud drives up healthcare costs for everyone. For those in South Florida with private or government insurance, the healthcare costs are the highest in the nation or close to it. Care for the average Medicare recipient in Miami costs twice as much as for a senior in Minneapolis. FRAUD IS A REASON Fraud is one reason for the higher costs here, Wilson and others are convinced. The Department of Justice has a warehouse in Miramar - the only one of its kind in the country - where prosecutors and investigators can store Medicare-fraud records and consult about investigations. The U.S. Attorney's office in Miami has a half-dozen prosecutors who work full time on healthcare criminal fraud plus 10 in Fort Lauderdale and West Palm Beach who dedicate most of their time to healthcare crimes. Another five are devoted to civil lawsuits involving fraud allegations. 'COULD BE . . . ANYONE' Medicare has a special office in Miami with seven employees who devote much of their time to fraud. And the FBI has about 20 agents dedicated to healthcare investigations. Most of the fraud here starts with someone's obtaining a senior's Medicare numbers. "It could be a nurse, " Jiménez said, "or anyone." The numbers then get sold to shady medical-supply firms. In many instances, those firms don't bother with checking accounts but use check cashers to get cash as soon as possible, according to David A, Frank, the federal prosecutor in charge of healthcare crimes in Miami. Leatrice Kaplitz, an Aventura senior, isn't sure how her Medicare information got out. Last spring, she received letters from Medicare saying it had paid $1,141.92 for 30 "drainable rubber pouches" ordered through M&V Medical Equipment of Miramar and $1,841.93 for a "locking elbow forearm control" through Kemp Medical Equipment of Hialeah. Unlike many seniors, Kaplitz reads her medical bills closely. She called Medicare's fraud telephone number and complained that she knew nothing about the devices. A PATTERN APPEARS In fact, even as more apparently fraudulent bills streamed into her apartment, investigators were seeing a pattern involving several dozen small medical-equipment firms tied to All-Med Billing Corp. Developing a criminal case in healthcare-fraud case can involve examining tens of thousands of pages of documents and take up to a year, Jiménez said. To stop the suspect companies in the meantime, prosectors went into federal court in August and asked for a restraining order that would prohibit them from continuing to bill Medicare. At that hearing, prosecutor Lisa Hu Barquist used an FBI agent's affidavit to indicate that Abner and Mabel Diaz had used All-Med to implement a "massive, aggressive, avaricious Medicare fraud scheme" that resulted in the government's paying their entities $122 million within four months. M&V and Kemp no longer have telephone listings and could not be contacted by The Herald. Attorneys for the Diazes did not immediately return phone calls. But, at the August hearing, the lawyer for Mabel Diaz, José M. Quiñon, said, "Some paperwork . . . appears to be part of a fraud, but that is not the Diazes' doing." The judge granted the restraining order. No criminal charges have been filed.

Corrections: In a story on 1,500 "professional patients" in Thursday's Business section, the number who complained about the effort was inaccurate. About 40 complained. * An Oct. 21 story in the Business section "Eye on professional patients" needs clarification. The company cited in the article as the target of healthcare fraud allegations by federal prosecutors is All-Med Billing Corp. of 7950 NW 155th St., Miami Lakes, whose president is Abner Diaz.