MEDICARE FRAUD UPDATE 07:
While Congress debates whether or not to reduce
>> Medicare payments to practitioners, task force officials are uncovering
>> increased amounts of fraud. Over nearly four years a
high school
>> dropout named Rita Campos electronically submitted more than 140,000
>> Medicare claims for unnecessary equipment and services. All it took to
>> bilk the federal government out of $105 million was a laptop computer.
>> After pleading guilty to filing false claims, she has helped
authorities
>> win indictments against more than half a dozen Florida doctors and
>> patients who allegedly accepted kickbacks for pretending to receive
>> costly
>> HIV drug therapy. With her cooperation, FBI agents this week arrested
>> three Miami-area men who, the government alleges, financed sham clinics
>> that billed the government more than $100 million. Sentenced to 10
years,
>> Campos Ramirez, 60, may yet reduce her prison term by helping
authorities
>> unwind "the large web of medical clinics, doctors, nurses, money
>> laundering companies and HIV clinic financiers who participated in this
>> massive fraud," prosecutors wrote earlier this year in court
papers. Her
>> lawyer did not return calls seeking comment.
>>
>> By many accounts, Campos Ramirez was unusually
successful.
>> Prosecutors
>> say that corrupt medical clinic owners anticipate that Medicare will
>> cover
>> a quarter of their phony claims. But Campos Ramirez persuaded
authorities
>> to cover 60% of all the bills she submitted on behalf of 75 HIV clinics
>> in
>> South Florida, according to court filings. Health-care experts say the
>> simplicity of Ramirez's scheme underscores the scope of the growing
fraud
>> problem and the need to devote more resources to theft prevention. Law
>> enforcement authorities estimate that health-care fraud costs taxpayers
>> more than $60 billion each year. A critical aspect of the problem is
that
>> Medicare, the health program for the elderly and the disabled,
>> automatically pays the vast majority of the bills it receives from
>> companies that possess federally issued supplier numbers. Computer and
>> audit systems now in place to detect problems generally focus on
>> overbilling and unorthodox medical treatment rather than fraud,
scholars
>> say.
>>
>> Daniel R. Levinson, the inspector general of
the Department of Health
>> an Human Services (HHS) has warned repeatedly that the Medicare
program
>> is "highly vulnerable" to fraud, particularly in South
Florida, where
>> schemes center on expensive, infusion-based HIV medications and on
>> equipment such as wheelchairs, walkers, canes and hospital beds.
>> Officials
>> from the Centers for Medicare and Medicaid Services (CMS), which
oversees
>> federally funded health programs, say they have stepped up their
efforts
>> to combat fraud over the past year by working closely with
investigators,
>> removing the requisite billing numbers of nearly 900 companies and
>> imposing new standards in high-fraud areas that would prevent people
>> convicted of felonies from ever receiving a Medicare number.
>> Investigators
>> and prosecutors trained their focus on Miami after noticing two
troubling
>> patterns:
>>
>> . HHS investigators discovered that nearly half of 1,581 medical
>> equipment
>> companies they visited in the Miami area did not comply with basic
>> Medicare requirements to be open during scheduled hours and to have a
>> telephone number. The inspector general and the Government
Accountability
>> Office have flagged weak oversight of these kinds of suppliers for a
>> dozen
>> years, according to congressional testimony.
>> . The South Florida region bills Medicare more than $2 billion each
year
>> for injectable HIV medications. That figure is 22 times as high as the
>> amount of similar claims in the rest of the country, and is far out of
>> line with demographic data in a population of 2 million people in
>> Miami-Dade County.
>>
>> Justice Department officials moved to freeze money in suspicious bank
>> accounts controlled by medical equipment company owners and they
created
>> a
>> Washington-based strike force to handle the issue. The strike force, in
>> concert with a small group of U.S. attorney's offices, has in the past
>> year opened nearly 900 criminal investigations and convicted 560
>> defendants in health-care fraud offenses throughout the country.
>> Authorities say the strategy is working. They point to a $1.75 billion
>> drop in Medicare claims in Miami since the operation began a year ago.
>> But
>> even government officials hope for a more comprehensive solution.
>> Christopher Dennis, the special agent in charge of the HHS inspector
>> general's office in Miami, said fraudulent medical equipment companies
>> appear to have shifted gears since the strike force arrived. After a
>> crackdown in South Florida, at least some corporate owners moved to the
>> north, he said. Investigators dubbed one initiative "Operation
>> Whack-a-Mole," after the carnival game in which a creature pops up
in
>> different places after being hit with a hammer.
>>
>> The strike force recently established a base in Los
Angeles, another
>> area rife with fraud. Prosecutors announced criminal charges last month
>> against two medical equipment company owners who are accused of falsely
>> billing Medicare more than $2 million. Plans call for a similar rollout
>> this fall in Houston, another potential fraud hot spot. Officials who
>> oversee the Medicare program say they are vigilant despite time
pressure
>> and limited resources. Employees review fewer than 5% of the nearly 1
>> billion claims filed each year. The vast majority of claims shuttle
>> through computer systems that are tweaked when authorities notice fraud
>> patterns. This year, CMS is working to finalize a rule that would
prevent
>> convicted felons from obtaining Medicare billing numbers. At present,
>> that
>> regulation applies only in a few high-fraud regions.
>> [Source: Washington Post Carrie Johnson article 13 Jun 08 ++]
>>