Carnival of Fraud

THE RECEPTIONIST
The receptionist did not look happy. Her mascara was streaked from tears, her dress rumpled to the hem, and her eyebrows, once slender brown lines, were now hoisted into apprehensive question marks. The frosted glass window behind which she generally sat, protected from the world, was flung open and she could see into the waiting room, where a trio of men in suits were murmuring to one another in English.

A half-hour earlier everything had been fine. It was just another March morning at the Gables Trauma Center, a diagnostic clinic tucked away in an office complex near the intersection of Calle Ocho and SW 40th Avenue.

Then a sweet little lady had walked in and asked for Dr. Mario Fonseca, which made sense -- it was his name, after all, that adorned the golden nameplate on the front door. But before the receptionist could explain that the doctor wasn't exactly available, the men with badges came barreling through the door. "We're from the state Department of Business and Professional Regulation," one declared. "This is an emergency inspection."

The agents fanned out through the clinic, then moved the employees into separate rooms and engaged in a game called Where's the doctor?

"Where's the doctor?" they asked.
The workers didn't know what to say. One ventured that the doctor was "out." Another explained that he was in Peru. A third merely shrugged. The truth of the matter was that Dr. Mario Fonseca was at the federal prison camp in Pensacola serving 21 months for medical fraud. The agents knew that. They'd been tipped off by a rental-car claims adjuster who had done a little background research about Gables Trauma after receiving medical reports from the clinic regarding two victims of an auto accident she suspected had been staged. The reports were signed by Fonseca.

What the agents actually wanted to know was this: Who examined patients at Gables Trauma? Their chief suspect turned out to be a short fellow with a gold watch and a snazzy blue suit. He identified himself as Enildo Marrero and insisted he was merely a quality-assurance worker who checked medical charts. The agents found this curious, inasmuch as his office contained an examining table.

An agent named Luis Collado plopped down at the receptionist's desk and used her phone to call another doctor whose name appeared in the clinic's records. The discussion was not encouraging. "What I'm trying to tell you is that Mr. Marrero is not a doctor," Collado emphasized. "He is not licensed to perform the activities you're telling me you saw him perform. I think you should find another place of business to operate."

The receptionist, eavesdropping from a nearby chair, bit her lip. Out in the hallway, one of the clinic's medical assistants hovered near the elevators in an apparent effort to divert any patients planning to visit the clinic. Both women looked terrified.

Collado and his cohorts, however, seemed almost bored. They appeared to regard the entire affair as no big deal, business as usual, just another day in the Medical Fraud Capital of the World.

Which it pretty much was.
There are hundreds of clinics like Gables Trauma in Dade. All you need is an occupational license in hand and a doctor's license on the wall, and you can start ringing up revenues to your heart's delight. And it doesn't matter if the doctor is dead, or in prison, because there's no real monitoring. DBPR agents occasionally muster the manpower for a raid, but unless they catch you engaged in a major medical fraud, there is little they can do besides open an investigation.

Which is precisely what happened on that March morning at the Gables Trauma Center. No arrests were made, no citations issued. The agents simply filled out some forms, confiscated a couple of boxes of business cards, and ripped the golden nameplate off the door with a loud thwap. Then, much to the receptionist's relief, they departed.

"We might as well open our own clinic with all this stuff," Collado mused, holding aloft the nameplate.

"Why not?" a colleague answered. "I'll bet the money beats state pay." Everyone laughed merrily and tromped off to lunch.

As of last week, the Gables Trauma Center was still in business. The woman who answers the phone there recalls the DBPR's visit a few months back. But she doesn't sound too concerned.

"That was just a routine inspection," she assures. "There is no problem here. No problem at all."

PSSST! HEY MAN, WANNA SCORE SOME MEDICARE?
When it comes to committing health-care fraud, that sentiment about sums up the mindset that now pervades South Florida.

Just as the drug trade defined the region's criminal underside during the go-go Eighties, fleecing health insurers is the creme de la scam of the Nineties. In March of this year, FBI director Louis Freeh marched onto Capitol Hill to announce that medical fraud is the fastest growing criminal enterprise in America, with an annual take of $44 billion. It's gotten so bad, Freeh told aghast congressmen, that certain street gangs in South Florida have abandoned cocaine sales for Medicare rip-offs.