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CBS/ AP/ July 17, 2010, 7:58 AM

Feds Bust 36 for Alleged Medicare Scams

Last updated at 6:44 p.m. ET

Federal authorities said Friday they are conducting the largest Medicare fraud bust ever in five different states and arrested dozens of suspects accused in scams totaling $251 million.

Several doctors and nurses were among those arrested in Miami, New York City, Detroit, Houston and Baton Rouge, La., accused of billing Medicare for unnecessary equipment, physical therapy and HIV treatments that patients typically never received. Ninety-four suspects were indicted, and authorities said 36 people had been arrested as of Friday morning.

More than 360 agents participated in Friday's raids, announced by Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius at a health care fraud prevention summit in Miami. Officials said they chose Miami because it is ground zero for Medicare fraud. Authorities indicted 33 suspects in the Miami area, accused of charging Medicare for about $140 million in various scams.

"With today's arrests we're putting would-be criminals on notice: health care fraud is no longer a safe bet," Holder said Friday.

Cleaning up an estimated $60 billion to $90 billion a year in Medicare fraud will be key to paying for President Barack Obama's proposed health care overhaul. Federal officials have promised more money and manpower to fight fraud, setting up strike forces in several cities.

Around the country, the schemes have morphed from the typical medical equipment scam in which clinic owners billed Medicare dozens of times for the same wheelchair, while never giving the medical equipment to patients. Now, officials say, the schemes involve a sophisticated network of doctors, clinic owners, patients and patient recruiters.

Experts say criminals see the system as an easy target, reports CBS News correspondent Elaine Quijano.

"I think it is generally regarded as more lucrative than the drug trade now," said Malcolm Sparrow, a professor of public management at the Harvard Kennedy School. "It's much safer - you are not going to be shot by your competitors."

For instance, agents bugged a medical center in Brooklyn, N.Y., where eight people are charged with running a $72 million scam that submitted bogus claims for physical therapy for elderly Russian immigrants. Clinic owners paid patients, including undercover agents, in exchange for using their Medicare numbers and a bonus fee for recruiting new patients. Recording devices captured hundreds of kickback payments in a private room where a man sat at a table and did nothing but pay patients all day, authorities said.

The so-called "kickback" room had a poster on the wall resembling Soviet-era propaganda, showing a woman with a finger to her lips and two messages in Russian: "Don't Gossip" and "Be on the lookout: In these days, the walls talk."

With the surveillance, the walls "had ears and they had eyes," U.S. Attorney Loretta Lynch said at a news conference in Brooklyn.

In a separate Brooklyn case, authorities indicted six patients who shopped their Medicare numbers to various clinics. More than 3,744 claims were submitted on behalf of one woman in the past six years. The patients did not receive the services billed to Medicare, authorities said.

"Today's arrests illustrate how health care fraud schemes can replicate virally and migrate rapidly across communities," said Daniel R. Levinson, inspector general of the U.S. Department of Health and Human Services, which oversees Medicare.

Federal authorities launched a strike force in Miami in 2007 to target the problem. The program has since expanded to seven cities and is responsible for more than 720 indictments that collectively have billed the Medicare program for more than $1.6 billion.

Miami-Dade County received about $520 million from Medicare in home health care payments intended for the sickest patients in 2008, which is more than the rest of the country combined, according to a federal report. Only 2 percent of the patients live here.

It used to take 90 days before the government detected a scam. By then, the crooks were long gone, sometimes with millions of dollars. Now authorities get billing data as it's submitted, allowing them to catch suspects in real time, "as opposed to the typical pay and chase model we've had for years," said Gerald Roy, assistant inspector general for investigations.
CBS/ AP
18 Comments Add a Comment
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h4x354x0r says:
How many millions has the fraud eradication effort cost so far?
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th9876 says:
This is fine, but how about going after hospitals that defraud the systems? Just going after little ole men and women who can't afford a decent defense just to look like your doing something is pitiful. When the government goes after buisinesses too, then I'll be impressed.
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ouchitatom says:
The people who steal in this fashion either don't realize or don't care that the trickle down effect will reach thier very own relatives and could possibly prevent them from receiving the medical care they will need in the future. By proxy they are hurting aNS POSSIBLY AIIDING IN THE DEATH OF SOME OF THIER RELATIVES.The Great Nation of the Cherokee does not have this problem since they bill themselves. It is a shame when the people of this Nation can't step back away from temptation to steal from one another.In my opinion these people should be put against a wall and shot.
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scottyusa says:
Go get em boys it's about time!
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myopinionpal says:
Feds should also bust our members of congress and any goverment employee
that uses their goverment credit card which is for work related purchases but some were used for personal purchases.
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scottyusa replies:
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I second that. Some of the biggest fraudsters are the ones the WE keep electing.
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retiredgustav says:
When I saw Baton Rouge as one of the locations of the fraud, I just wonder how long it will take before Louisiana?s wonder boy
Piyush (Bobby) Jindal's name to pop up in an investigation. He was the Secretary of the Louisiana Department of Health and Hospitals for many years.
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TC641 says:
Yeah OK....but where are the arrests and perp walks for the federal govt employees in the renamed MMS at,and those in the oil industry and lobbies who fueled their drunken coke filled orgies. And those so called inspectors who routinely submitted industry supplied inspection reports as their own work. And the new head of that renamed agency says there will be no witch hunt to root out the bad apples as it would demoralize an already stricken agency to do so. The Dept of Justice (dont worry guys (MMS) ya got a freebie....wink....wink)what a joke our govt is playing on us.
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jimbot1957 says:
A lot of this fraudulent activity would go away if the Medicare recipients had to pay for the medical services and apply for a reimbursement from the Govt.
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stsebastian replies:
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Oh, yeah, I'm sure all the seniors in nursing homes, who can barely function as it is, all have several hundred thousand dollars a year just laying around to pay for the medical services in the first place, let alone can afford to wait to reimbursed. Try living in the real world, jimbot. It might surprise you.
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scabbard2 says:
Great job, publish pictures of the arrests and the store fronts, name the companies and the alleged scammers. Set some stiff mandatory sentences like those for crack cocaine and send these people to jail. If the accused are legal aliens and they are convicted, jail time, revoke their status and send them back "home". If they are here illegally, jail time, deport them "home". Feds, make sure you freeze their assets now and seize all assets on indictment. I want to see pictures in post offices of the slime that are stealing from everyone in our country. Something like that or this whole thing is just words on paper.
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fedup12 says:
Getem holder.

Just fine the heck out of them till they are destitute then fine em some more.

Get even for the other thousands that are out there scammin the feds
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