By Terrence McCoy
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While the specter of street-corner crack boyz dealing Medicare cards may seem just a tad on the panicky side, medical fraud plainly has been anointed an official CRISIS, and, as with any CRISIS, there is political hay to be made by playing it to the hilt. Thus, while Senate subcommittees cluck and national TV magazines broadcast local atrocities to the rest of the country, state and federal authorities are engaged in a mad dash to beef up enforcement.
U.S. Attorney Kendall Coffey, who has doubled the manpower devoted to prosecuting medical fraud here, calls it "a two-billion-dollar-a-year problem in South Florida." If he's right -- and nobody knows, really -- that would mean that our little peninsula accounts for nearly five percent of the entire nation's loss.
Most of that moolah comes from you, the taxpayer. That's because the primary target of fraud is the federal Medicare program, which administers health care to the elderly, and Medicaid, a state-run program to provide care to the indigent that is jointly funded by the state and feds.
One General Accounting Office study projects that, at the current rate, the Medicare system will be bankrupt by 2010.
How did this happen?
KEEP THE DOCTORS HAPPY
It all started so earnestly. The idea, knocked around first by Harry Truman, was to provide a national health insurance program. Sound familiar? Well, it didn't go over too well back then, either. The proposal was soon scaled back to include only the elderly (Medicare) and the needy (Medicaid). Eligible patients would be treated by approved providers, who in turn would be reimbursed by the government.
Lyndon Johnson, taking his cue from John Kennedy, made the passage of the Meds his top priority. Exactly 30 years ago this July he signed the bills into law. He did so, however, over fierce opposition from the American Medical Association, which went so far as to mount a public ad campaign against the proposal. Fearing the Meds would lead to a system of socialized medicine, many doctors boycotted the new legislation.
This was a problem. The fledgling programs were desperately dependent on the cooperation of doctors and other health-care providers. After all, if no one agreed to treat Medicare and Medicaid patients, the whole scheme would be useless.
Thus arose an unhealthy dynamic. Administrators designed a system that stressed the interests of health-care providers above all else. They made it remarkably easy to become a provider, and they guaranteed speedy reimbursement of all claims. It was a system founded on trust. The idea that doctors might defraud the system never really occurred to anyone, though it did seem disturbing that some raised their fees for treatment of the elderly as much as 300 percent upon the passage of the Medicare bill.
Initial forms of fraud were strictly nickel-and-dime. Billing for a medical exam that was really just a visit. Ordering an unnecessary diagnostic test or two. But in the past decade professional fraudsters have stepped in, often with the cooperation of unscrupulous M.D.'s. Today the General Accounting Office estimates that more than twenty percent of all Medicare claims in South Florida are bogus, a figure federal prosecutors say may be too low.
"If we stopped medical fraud tomorrow, the whole city would shut down," says one state agent, only half-jokingly.
Why has South Florida become the mecca of medical fraud? The answer seems to be a collision of factors.
First and foremost, there is a tremendous base of recipients here, i.e., old and/or poor people. Many are immigrants who don't speak English, have no idea how the Meds work, and thus are easily exploited. The ignorance on the part of health-care providers themselves seems a bit more willful. "Some of these people honestly think the U.S. government is in the business of printing money," says one FBI agent. "You can try to explain that they're breaking the law. But until you arrest them they just keep operating."
A culture of carpetbaggers, South Florida has long been attractive to grifters. Folks down this way seem refreshingly open to new business ventures and loath to question pedigrees or ethics. There is also easy access to offshore companies, foreign bank accounts, and, should it become necessary, an escape route.
To truly appreciate the CRISIS, though, it is best to deal in specifics. Thus, without further throat clearing, we present a few of the entrepreneurs who have made South Florida the carnival of fraud it is.
Dr. Imo was a skinny man who wore a lab coat and tennis shoes and spoke righteously about the need to provide AIDS education to the disenfranchised. As a measure of his devotion, he was fond of distributing to residents of Liberty City and Little Haiti coupons that could be redeemed for condoms at his NW 79th Street health-care facility, which was called International Humanity. He also carried business cards that read "Dr. Imo John Akpaeti, M.D."
Dr. Imo wasn't a licensed doctor. He claimed to have earned that distinction in his native Nigeria, but as far as the State of Florida was concerned, he was just an X-ray technician. Still, he was an energetic fellow with a silver tongue, and his unorthodox approach to AIDS education quickly won favor with the state Department of Health and Rehabilitative Services (HRS), which gave his clinic more than $70,000 in grants in 1988. AIDS prevention was only a sideline for Dr. Imo, though. His specialty was home health care.