Medicaid and Medicare

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The Medicare program – government subsidized health insurance for people 65 and older, and others who qualify – recently celebrated its 44th birthday. It was signed into law by President Lyndon B. Johnson on July 30, 1965.

Today, bloated with government funds, Medicare pays out a half trillion dollars in benefits each year. Yes, that’s trillion with a T – and that figure has not gone unnoticed by criminals in search of easy money. In fact, it is so easy to defraud Medicare that shysters are raking in $60 billion a year, making Medicare fraud the most profitable crime in America.

Like Taking Candy From A Baby…

In a story that aired on the CBS program 60 Minutes on October 25, 2009, correspondent Steve Kroft spent several days on the beat in south Florida with FBI Special Agent Brian Waterman. They drove to numerous small clinics and pharmacies in low rent locations where the businesses stood locked and unstaffed. Some had been stripped and closed, others never existed since they were simply the address of a public storage facility.

What each of those so-called businesses has in common is the stupendous amount of money they’ve bilked from Medicare. Figures like $1-2 million dollars a month. No wonder drug dealers are turning to Medicare fraud. It’s more profitable than cocaine and not nearly so risky.

One convicted fraudster said he woke up to deposits from Medicare in his bank account of $20,000, $30,000, even $40,000 a day. He figures he netted about $20 million overall and all he had to do was set up a fake storefront, buy lists of Medicare patients complete with names, date of birth and Social Security numbers, then send in the fictitious forms.1

It was “like taking candy from a baby”, commented the con-man. Further, if anything went wrong – say a charge is questioned – you simply shut down the business and start over somewhere else. Easy enough since Medicare is required by law to pay claims in 15-30 days and any investigating gets done later. By then it’s too late.

Quiet Crime?

That’s what the 60 Minutes report called this rampage of Medicare fraud: “It’s a quiet crime – there are no sirens or gunfire. The only victims are the American taxpayers…” But I have to disagree. With millions of dollars being as easy pickings as the lowest fruit on a tree, you can be sure some pretty big players are joining the game. Miami FBI spokeswoman, Judy Orihuela confirmed that Mafia figures and violent criminals are coming on the scene and they don’t play as nice as the white-collar offenders.2

A Miami pharmacist was found dead in her shop in 2007. Her cousin was charged with the murder, which was related to a Federal investigation of the pharmacy for Medicare fraud.
One week after the FBI issued search warrants to over 50 fake Medicare storefronts in Miami, the informant in the case was found shot to death in his car. He would have been able to clarify the $148 million fraud scheme. His murder is unsolved.
Armenian gangs in Los Angeles aggressively pursue elderly patients, intimidating them to get their Medicare numbers, even kidnapping them until they cooperate.
An Illinois podiatrist got the death penalty for shooting one of his patients to keep her from testifying against him for Medicare fraud. She was found dead in her wheelchair in her home, subpoena lying on the floor next to her.

Los Angeles County Sherriff’s Sgt. Stephen Opferman comments that the violent crimes are mostly to settle a debt or silence a witness. “It’s in-house. Typically professional hits, generally unsolved. Usually it’s just a bullet in the head, nobody saw anything.”3

Quiet crime? I don’t think so.

We All Foot the Bill

This is a complex problem and the agencies involved have their work cut out for them. Medicare needs better screening of claims and more investigators – all while upholding appropriate doctors’ health care decisions and patients’ privacy. A balance the government is not known for. And the criminals will always be circling in the background, finding new ways to defraud the system.

The bottom line, however, is that American taxpayers – you and I – are footing the bill for this mess. If you’re on Medicare, or have a loved one who is, here are a few things you can do:

Don’t give out your Medicare number to anyone but your legitimate health care provider
Don’t leave your Medicare number in a phone message
Don’t accept “free” services or supplies in return for your Medicare number
Avoid health care suppliers who say they know how to get Medicare to pay for non-covered services
Check your medical bills for correct charges of services and prescriptions actually received

Right now, those things might seem to be just a finger in the dike, but it is going to take diligence by all of us to break the stranglehold that crime has on Medicare. Unfortunately, it affects us all.

As always, consult your personal physician before making any changes to your diet, exercise or supplement routine.

Sources:

Tenenbaum, David, “Heading For Trouble”, University of Wisconsin, Nov 20, 2003, whyfiles.org
Mitchell, Deborah, “Alzheimer’s Disease, Memory Problems Common Among NFL Players”, emaxhealth.com, Sep 30, 2009
Mitchell, Deborah, “Alzheimer’s Disease, Memory Problems Common Among NFL Players”, emaxhealth.com, Sep 30, 2009
Mitchell, Deborah, “Alzheimer’s Disease, Memory Problems Common Among NFL Players”, emaxhealth.com, Sep 30, 2009
Tenenbaum, David, “Heading For Trouble”, University of Wisconsin, Nov 20, 2003, whyfiles.org
Tenenbaum, David, “Heading For Trouble”, University of Wisconsin, Nov 20, 2003, whyfiles.org
Tenenbaum, David, “Heading For Trouble”, University of Wisconsin, Nov 20, 2003, whyfiles.org

Posted in Medicare | Tags: Business, Colossal, Dirty, Fraud, Medicare | 15 Comments »