BUSTED: Federal Agents Crack Medicare Fraud Operations in 5 Cities

[stlsaxman]

Source: ABC

Federal agents swept down on alleged Medicare fraud operations in five cities this morning , charging 94 people with submitting more than $251 million in false claims to the government. Agents executed search warrants and made arrests in Miami ; Baton Rouge, La.; Brooklyn, N.Y.; Detroit and Houston. *snip*

Attorney General Eric Holder said today's arrests were the largest health care fraud takedown since a special Medicare fraud strike force unit was established in 2007 *snip*

Read more: http://abcnews.go.com/WN/government-agents-uncover-medicare-fraud-operations-cities/story?id=11180320

[hedgehog]

1. I guess George's people couldn't find these outfits because they

were too busy looking for WMD!

That $251 million will go a ways to paying for the Health care Reform bill!

[siligut]

2. The tip of the iceberg.

A conspiracy of fraud that goes deep and wide. MDs, Nurses, billers, insurance companies and unknowing patients, cheating the government and the rest of us. I worked in Florida and these people have deception down to a science. They were all involved, from the providers to the payers, kick backs and greed, working together to get theirs before they bankrupt the system.

[activa8tr]

7. A little more than the tip, I'd say. Given the number of

doctors and providers, and the number of legitimate providers in the nation, I'm sure this is MORE THAN just the tip.

Having worked for two legitimate doctor-ordered medical service provider, we bent over backwards NOT to overcharge, and to correct any errors in billing within a month, for fear of the Feds.

I may be naive, not living in FL or TX or NYC, but most of the medical service providers I have had contact with tried their best to do their jobs accurately, not screw the Feds, and they had about the same level of paranoia and fear of being accused of fluffing up our bills.

I'm REALLY REALLY GLAD these bums were arrested, I hope we get most, if not all of them and throw them in jail in some third world country for life!

[Bluenorthwest]

23. Accordint to the government Medicare fraud is about 60 billion

a year. So tip of the iceberg, it seems.

[druidity33]

26. that seems high...

got a link for that stat?

:)

[dmr]

29. It's in the OP's link. Approx 60 billion dollars

Here's another link found in the above story:
http://abcnews.go.com/Nightline/medicare-fraud-costs-taxpayers-60-billion-year/story?id=10126555

A four month "Nightline" investigation into Medicare fraud makes one thing perfectly clear: this is a crime that pays and pays and pays. The federal government admits that a staggering $60 billion is stolen from tax payers through Medicare scams every year. Some experts believe the number is more than twice that.
With a health care bill pending, see how Medicare fraud really works.

Fraudulent pharmacies, clinics and medical supply companies seem to pop up like mushrooms in South Florida, the area widely considered to be ground zero in the fight against a crime that requires little training and involves few risks.

Former car mechanics and drug dealers, bus boys and clerks can be involved in individual scams, taking tens of millions of dollars every year from the government program designed to provide health care to the nation's elderly. As one government official told "Nightline," having a Medicare license is having a license to steal.

The victims of the schemes? American taxpayers.

More at link (interesting article, too)

[defendandprotect]

18. PLUS, many of the billings by doctors are outrageous . . . especially

when seen against competent, honest and highly professional doctors who bill more

fairly!

[Sgent]

34. Billings don't really matter

Medicare decides what they are going to pay, and the doctor must accept that amount (the allowable) as payment in full.

[alp227]

3. K&R for saving stolen money. now END THE WARS! n/t

[tilsammans]

4. This is great!

:applause:

Years ago, I called Medicare to report a firm that I suspected of fraud. I was told that they didn't investigate any matter under $100,000. Never mind that it doesn't take long for a few fraudulent charges to add up and exceed that number.

Lock up all the fraudsters and throw away the key!

[patrice]

5. K & R

[Prisoner_Number_Six]

6. Wanna bet they're given a pennies-on-the-dollar fine?

No way anyone's gonna have the courage to actually demand these yokels pay all that money back.

Jeez, I'm getting cynical in my old age...

[activa8tr]

8. How about they all lose their license to practice, and spend some

serious jail time?

I'm betting most of these crooks were Republicans, too, gave $ to Republican candidates.

[Tx4obama]

15. Housing people in jail/prison costs money

it's better to keep them out of jail but make them pay back the medicare money and also a huge fine.

[global1]

9. That's Only Five Cities -This Is Going On All Over The Country.......

I hope they bust this fraud throughout this country. I never could understand that the credit card companies have their act together to stop credit card fraud and abuse - but the government couldn't do the same for Medicare fraud. The technology is there to prevent this if they were serious in stopping the Medicare fraud and abuses.

[truthisfreedom]

10. Wow, 5 cities so far... we have 276 cities with populations over 100,000.

I wonder if there's 100 billion in fraud?

[Ex Lurker]

11. I hope they bust the free scooter people n/t

[grahamhgreen]

14. YES!!!! These free scooter con artists must go to jail!!!!!!

I have been shocked by this since the first time I saw an ad.

[Bitwit1234]

12. Was the Frist Family Hospital and Medical Clininc among them

they got caught once before for submitting over 2M just themselves. Course nothing ever came of it, Frist at the time was in charge of the senate.

[EFerrari]

13. Anyone seen Jeb Bush lately?

[Judi Lynn]

16. What's a Medicare/Medicaid fraud without Miami, right-wing Cubans, Jeb Bush?

the right-wing Cuban thugs have always been thick as thieves with _{Jeb Bush.}

Jeb Bush's best pal, Miguel Recarey pulled off the largest fraud on record at the time, as you know. Here's a memory refresher for others:

TRUST OR HUSTLE: The Bush Record
David E. Scheim

~snip~
JEB BUSH. In 1987, Miguel Recarey, a longstanding business associate of Tampa Mafia boss Santos Trafficante, fled the U.S. under three indictments for labor racketeering, illegal wiretapping, and Medicare fraud.1 His firm, International Medical Centers (IMC), which was America’s largest health maintenance organization for the elderly and which had received $1 billion in Medicare funds, collapsed.2 Recarey’s HMO left $222 million in unpaid bills,3 and was suspected of up to $100 million in Medicare fraud.4 “IMC is the classic case of embezzlement of government funds,” said William Teich, who headed the U.S. Office of Labor Racketeering in Miami. Teich called it a “bust-out operation” where money was “drained out the back door” and disappeared down “a black hole.”5

But in 1985, Recarey had faced a major obstacle to building his Medicare empire: a Department of Health and Human Services (HHS) regulation that restricted an HMO to drawing no more than 50% of its revenue from Medicare.6 Jeb Bush came to the rescue: he called both HHS Secretary Margaret Heckler and a top aide, C. McLain Haddow and successfully convinced them to waive the regulation for Recarey, Haddow testified to Congress.7 Bush’s lobbying of HHS took place during the same period that top-level Republican lobbyists whom Recarey had hired for $1 million were also courting HHS for the waiver.8 Bush said that said he did not recall making any calls to Heckler or Haddow, but confirmed that he made one call on Recarey’s behalf to Haddow’s assistant, to secure Recarey a “fair hearing” within HHS.9

Haddow added in a news interview that in November 1984, Jeb had also called Heckler and Haddow for Recarey about another problem - complaints to HHS from doctors and patients about IMC’s medical care and allegations that Recarey had embezzled funds a few years earlier from another hospital.10 Bush had told Haddow that “contrary to any rumors that were floating around concerning Mr. Recarey, that he was a solid citizen from Mr. Bush’s perspective down there , that he was a good community citizen and a good supporter of the Republican Party.”11

In 1986, the year after he successfully lobbied HHS to allow Recarey’s Medicare business to grow ultimately to a total of $1 billion, Jeb Bush’s small real estate firm received $75,000 from Recarey’s HMO for the purpose of finding it a new headquarters.12 Bush said that the payment was unrelated to his lobbying for Recarey.13 But Bush never did actually locate a headquarters for IMC, and the record suggests that the HMO had already selected the headquarters it ultimately moved into when it hired Bush.14 Jeb confirmed that he received $75,000 from Recarey without closing any real estate deals.15

More:
http://www.campaignwatch.org/more1.htm

~~~~~

Bush Family Value$
The Bush clan's family business
— By Stephen Pizzo

~snip~
Jeb and Miguel Recarey
With Miami awash in empty office space in 1986, it was no small event when bagged International Medical Centers as a key tenant for Padreda's HUD-financed building. IMC, which leased nearly all the space in Padreda's vacant building, was at the time one of the nation's fastest-growing health-maintenance organizations (HMO) and had become the largest recipient of federal Medicare funds.

IMC was run by Cuban-American Miguel Recarey, a character with a host of idiosyncrasies. He carried a 9-mm Heckler & Koch semiautomatic pistol under his suit coat and kept a small arsenal of AR-15 and Uzi assault rifles at his Miami estate, where his bedroom was protected by bullet-proof windows and a steel door. It apparently wasn't his enemies Recarey feared so much as his friends. He had a long-standing relationship with Miami Mafia godfather Santo Trafficante, Jr., and had participated in the illfated, CIA-inspired mob assassination plot against Fidel Castro in the early 1960s. (Associates of Recarey add that Trafficante was the money behind Recarey's business ventures.)

Recarey's brother, Jorge, also had ties to the CIA. So it was no surprise that IMC crawled with former spooks. Employee résumés were studded with references to the CIA, the Defense Intelligence Agency, and the Cuban Intelligence agency; there was even a fellow who claimed to have been a KGB agent, An agent with the U.S. Office of Labor Racketeering in Miami would later describe IMC as a company in which "a criminal enterprise interfaced with intelligence operations."

Recarey also surrounded himself with those who could influence the political system. He hired Jeb Bush as IMC's "real-estate consultant." Though Jeb would never close a single real-estate deal, his contract called for him to earn up to $250,000 (he actually received $75,000). Jeb's real value to Recarey was not in real estate but in his help in facilitating the largest HMO Medicare fraud in U.S. history.

Jeb phoned top Health and Human Services officials in Washington in 1985 to lobby for a special exemption from HHS rules for IMC. This highly unusual waiver was critical to Recarey's scam. Without it, the company would have been limited to a Medicare patient load of 50 percent. The balance of IMC's patients would have had to be private -- that is, paying -- customers. Recarey preferred the steady flow of federal Medicare money to the thought of actually running a real HMO. Former HHS chief of staff McClain Haddow (who later became a paid consultant to IMC) testified in 1987 Jeb that directly phoned then-HHS secretary Margaret Heckler and that it was that call that swung the decision to approve IMCs waiver.

Jeb admits lobbying HHS for the waiver, but denies talking to Secretary Heckler -- and denies as well the charge that his call won the HHS exemption. "I just asked that IMC get a fair hearing," said later. After the IMC scandal broke in 1987, Heckler left the country, having been appointed U.S. ambassador to Ireland, a post she held until 1989. (Heckler is now a private citizen living in Virginia. We left a detailed message with her secretary, outlining our questions, but she declined to respond.)

More:
http://motherjones.com/politics/1992/09/bush-family-value

~~~~~‘Frauds-R-Us’
The Bush Family Saga
Part II - Part I Here

International Medical Centers
The Jeb Bush Connection
By William Bowles

~snip~
The president's younger brother was also on the payroll in the 80s of the prominent Cuban exile Miguel Recarey, who had earlier assisted the CIA in attempts to assassinate President Castro.

Recarey, who ran International Medical Centers (IMC), employed Jeb Bush as a real estate consultant and paid him a $75,000 fee for finding the company a new location, although the move never took place, which raised questions at the time. Jeb Bush did, however, lobby the Reagan/Bush administration vigorously and successfully on behalf of Recarey and IMC. "I want to be very wealthy," Jeb Bush told the Miami News when questioned during that period.

In 1985, Jeb Bush acted as a conduit on behalf of supporters of the Nicaraguan contras with his father, then the vice-president, and helped arrange for IMC to provide free medical treatment for the contras.

Recarey was later charged with massive medicare fraud but fled the US before his trial and is now a fugitive.

More:
http://www.informationclearinghouse.info/article3335.htm

[SpiralHawk]

21. "Smirk" - Da Jebster (R - Chickenhawk Profiteer)

[JDPriestly]

22. Wow! I have long believed there was some kind of link between

the Bush family and some sort of Mafia organization. There it is. There are other indications -- the whole Abramoff scandal and the Bush tie to Cuban interests pre-Castro. But here is yet another key bit of evidence. Thanks.

[glitch]

31. Fraud a Bush family specialty, but insurance (and securities) was Junior's specialty

Not that Jeb can't diversify.
http://www.williambowles.info/ini/ini-015.html
snips:
"You can fool some of the people all of the time, and those are the ones you have to focus on" — GW Bush

"You have to look at the entire Bush Family in this context -- as if the family ran a corporation called ‘Frauds-R-Us,’
George Jr.’s specialty was insurance and security fraud.
Jeb’s specialty was oil and gas fraud.
Neil’s specialty was real estate fraud.
Prescott’s specialty was banking fraud.
And George Sr.’s specialty? All of the above." -- Lt. Cmdr. Al Martin, US Navy,(Ret)

"What you’ve got with Bush is absolutely the largest number of siblings and children involved in what looks like a never-ending hustle." -- Republican pundit Kevin Philips

[Lochloosa]

17. Not to worry. They will just run for Governor on day.

[defendandprotect]

19. We should remember that pharma/drug companies are the biggest thieves ...

ripping off Medicare --

Many huge fines -- no acknowledgment of wrongdoing, as I recall --

in the area of vitamin companies, it was an organized conspiracy to defraud!

Rep. Bernie Sanders has been very informative on this subject!

[stltduggan]

20. the conservatives

the conservatives would lead you to believe that it is the "illegals" and poor who are cheating the system by getting their health care on Medicaid, but as you can clearly see even if there is some fraud there it pales in comparison to the health care providers who are hijacking the system. According to the right we certainly do not need health care reform......now you know why it is like every other big business the right panders to.. too many dollars going in the coffers.

[burnsei sensei]

24. I hope this is only the beginning.

The government can police health insurance fraud infinitely more efficiently than any private insurance outfit.
This is just another leg in the long-term argument for single-payer.

[Jane Austin]

25. Wait a minute -

I thought it was illegal aliens that would run up the costs of Medicare by seeking, you know, medical care!

:sarcasm:

[sendero]

27. Recently....

.... my wife took her son to a doctor who took Medicaid. A couple of weeks later she went back and got a copy of his chart for reasons I don't remember.

In the chart were details of services and procedures he DID NOT RECEIVE.

My wife went to their office and pointed this out. The doctor quickly "corrected" the chart. My wife reported this to the appropriate officials anyway. There is about a 95% chance that this was pure fraud.

I'd say that this sort of fraud is pretty pervasive. Not the full blown "billing for patients you have never seen" type, but the "billing for procedures you did not do" type.

[Bozita]

28. Bullshit! Fmr Sen Bill Frist's family business was the biggest Medicare fraud in history - DOJ docs

Republican leader of the US Senate and heart surgeon specializing in remote diagnostics.

$1.7 FUCKINGBILLION ... Isn't that bigger than $251 million? ... Maybe almost 7 times bigger?

Check it out ...

http://www.justice.gov/opa/pr/2003/June/03_civ_386.htm

FOR IMMEDIATE RELEASE
THURSDAY, JUNE 26, 2003
WWW.USDOJ.GOV
CIV
[phone]
TDD [phone]
LARGEST HEALTH CARE FRAUD CASE IN U.S. HISTORY SETTLED
HCA INVESTIGATION NETS RECORD TOTAL OF $1.7 BILLION


WASHINGTON, D.C. - HCA Inc. (formerly known as Columbia/HCA and HCA - The Healthcare Company) has agreed to pay the United States $631 million in civil penalties and damages arising from false claims the government alleged it submitted to Medicare and other federal health programs, the Justice Department announced today.

This settlement marks the conclusion of the most comprehensive health care fraud investigation ever undertaken by the Justice Department, working with the Departments of Health and Human Services and Defense, the Office of Personnel Management and the states. The settlement announced today resolves HCA's civil liability for false claims resulting from a variety of allegedly unlawful practices, including cost report fraud and the payment of kickbacks to physicians.

Previously, on December 14, 2000, HCA subsidiaries pled guilty to substantial criminal conduct and paid more than $840 million in criminal fines, civil restitution and penalties. Combined with today's separate administrative settlement with the Centers for Medicare & Medicaid Services (CMS), under which HCA will pay an additional $250 million to resolve overpayment claims arising from certain of its cost reporting practices, the government will have recovered $1.7 billion from HCA, by far the largest recovery ever reached by the government in a health care fraud investigation.

"Health care providers and professionals hold a public trust, and when that trust is violated by fraud and abuse of program funds, and by the payment of kickbacks to the physicians on whom patients and the programs rely for uncompromised medical judgment, health care for all Americans suffers," Robert D. McCallum, Jr., Assistant Attorney General for the Civil Division said. "This settlement brings to a close the largest multi-agency investigation of a health care provider that the United States government has ever undertaken and demonstrates the Department of Justice's ongoing resolve and commitment to pursue all types of fraud on American taxpayers, and health care program beneficiaries."

"Let this case be a continuing reminder to all that in the fight against health care fraud this office will not be deterred," said Acting Principal Deputy Inspector General Dara Corrigan. “Medicare dollars paid to provide ever more expensive health care services to the country's taxpayers should never be fraudulently diverted. This is our job and our trust and we take these duties very seriously," Corrigan concluded.

This latest settlement resolves fraud allegations against HCA and HCA hospitals in nine False Claims Act qui tam or whistleblower lawsuits pending in federal court in the District of Columbia. Under the federal False Claims Act, private individuals may file suit on behalf of the United States and, if the case is successful, may recover a share of the proceeds for their efforts. Under the settlement, the whistleblowers will receive a combined share of $151,591,500, the highest combined qui tam award ever paid out by the government.

"We are grateful for the assistance given by the whistleblowers over the course of the past nine years of investigation and litigation,” McCallum said. “And we are proud of the work of government personnel as well as counsel for the whistleblowers, who together pursued these matters through investigation and strenuous litigation. This result demonstrates the commitment of the Department to the qui tam statute and that the statute works as Congress intended."

Under the first of three agreements announced today, which becomes effective upon the court's dismissal of the lawsuits, HCA will pay nearly $620 million to resolve eight whistleblower lawsuits in which the government had intervened alleging that HCA systematically defrauded Medicare, Medicaid and other federally funded health care programs through schemes dating back to the late 1980s. HCA will pay an additional $11 million to resolve separate allegations of improper HCA billing practices.

The settlement requires HCA to pay:

$356 million to resolve whistleblower lawsuits alleging that HCA engaged in a series of schemes to defraud Medicare, Medicaid and TRICARE, the military’s health care program, through hospital cost reports, the year end claims submitted by hospitals to the government to reconcile payments received throughout the year with amounts they claim are actually owed. In 2001, a subsidiary of Nashville-based HCA, Columbia Management Companies, Inc., pled guilty in the Middle District of Florida to related charges on eight counts of making false statements to the United States and paid $22.6 million in criminal fines. An additional amount of $20 million of the settlement is being paid toward a resolution of cost reporting fraud allegations pursued separately by James Alderson and John Schilling, the relators who filed the lawsuits. In total, the two relators are to receive a total of $100 million as their statutory share of the settlement.

$225.5 million to resolve lawsuits alleging that HCA hospitals and home health agencies unlawfully billed Medicare, Medicaid and TRICARE for claims generated by the payment of kickbacks and other illegal remuneration to physicians in exchange for referral of patients. In 2001, Columbia Management Companies, Inc., pled guilty to one count of conspiracy to pay kickbacks and other monetary benefits to doctors in violation of the Medicare Antikickback Statute and paid a $30 million criminal fine. Dr. James Thompson, a doctor who filed suit against the company in 1995, will receive $41.5 million as his statutory share of the settlement. Gary King, a former HCA employee, will receive $5 million and Ann Mroz, a former HCA nurse, will receive a share of $837,500.

$17 million to resolve allegations that certain company-owned hospitals billed Medicare for unallowable costs incurred by a contractor that operated HCA wound care centers, and for a non-covered drug that the contractor manufactured and sold to hospital patients. The 2001 Columbia Management Companies' guilty plea concerning cost report fraud included a charge related to wound care center costs. HCA's wound care center management contractor, Curative Healthcare Services, Inc., previously paid $16.5 million to resolve related allegations pending at one time in these same lawsuits. Joseph "Mickey" Parslow, a former HCA financial officer, will receive $2,990,000 and Francesco Lanni, a former Reimbursement Manager at the Wound Care Center at New York Methodist Hospital in Brooklyn, New York, will receive a share of $680,000.

$5 million to resolve allegations concerning the transfer of patients from HCA facilities to other facilities and the claiming of excessive costs for those transfers.

$5 million to resolve allegations that HCA's Lawnwood Regional Medical Center in Fort Pierce, Florida submitted false claims in Medicare cost reports by inflating its entitlement to funds to treat indigent patients and by shifting employee salary costs in order to increase its reimbursement from the federal health care program.

$950,000 to settle allegations made by Michael Marine that HCA improperly shifted its home office costs to hospitals. Marine will receive a share of $116,500.

Today's settlement agreement incorporates the terms of a Corporate Integrity Agreement executed by HCA and the Office of the Inspector General, Department of Health and Human Services in December 2000 that obligated the company to engage in significant and comprehensive compliance efforts into 2009.

In a separate agreement, HCA agreed to pay $1.5 million to resolve allegations that an Atlanta, Georgia hospital, West Paces Medical Center, paid kickbacks for the referral of diabetes patients. Those allegations had been pursued since 1996 by a whistleblower in a case in which the United States had declined to intervene, captioned U.S. ex rel. Pogue v. American Healthcorp, Inc. et al.. Pogue, a former employee of a co-defendant in the case, Diabetes Treatment Centers of America, will receive a share of $405,000 from the HCA settlement. Pogue continues to litigate claims against his former employer and a group of Atlanta physicians.

Additionally, a state negotiating team appointed by the National Association of Medicaid Fraud Control Units has reached agreement with HCA to resolve related issues with affected state Medicaid plans for $17.5 million, representing direct state losses. The terms of that agreement are being finalized by the parties and are not part of today's settlement.

Today's administrative agreement between HCA and CMS will require HCA to pay CMS $250 million in order to resolve claims they maintained against each other arising from HCA's hospital cost reports and home office cost statements for cost reporting periods ending July 31, 2001. These claims resulted from HCA cost reports that were not processed since 1997 as a result of the government's investigation.

###

03-386

[Judi Lynn]

30. Looks as if Holder meant largest since 2007.

The O.P. said: ....largest health care fraud takedown since a special Medicare fraud strike force unit was established in 2007."

What a filthy shame the Frists, and Senator Bill Frist will never have to endure the indignity of being branded the criminals they are.

Thanks for the information.

[Turbineguy]

32. More Republicans out of the voting pool.

[BreweryYardRat]

33. Damn good news.

Seize their assets and throw them in prison.