Carnival of Fraud

Step right up and be astounded by Miami's bizarre side show of Medicare and Medicaid scammers! After all, you're paying for it!

Home health care came into vogue a few years ago as a way of shortening hospital stays by having visiting nurses tend to patients at home. Home health was supposed to save the system money; instead, it created another ride in the carnival of fraud. All it required was a registered nurse, a procedures manual, a central location, and the names and billing numbers of patients. An industrious man like Dr. Imo had no problem earning admission. From March 1989 through June 1990, companies he owned and/or operated charged Medicaid more than one million dollars.

As is so often the case with health-care fraud, detection was more the result of dumb luck than diligence.

Throughout the late Eighties, a Medicaid fraud unit investigator named Nestor Abuan had busted a string of home-health companies owned by a Nigerian couple named Patrick and Ino Inwang. In April 1990, an elderly woman who had served as a witness in the Inwang cases called Abuan. Her complaint this time was about Dr. Imo.

Records reflected that Dr. Imo was seeing many of the same patients the Inwangs did. He was billing Medicaid for up to three home visits a day, seven days a week. Many of his patients did not need the services; others never received them. A few were dead.

The authorities shut down Dr. Imo's local operations, but the wheels of justice were slow in turning. By the time he was indicted in late 1992, Dr. Imo had broadened his business horizons by opening a home health-care service in Louisville and attempting to start another in New Jersey. While awaiting trial in Miami, he was charged with fraud in Kentucky.

Dr. Imo was indignant to the end. In court he railed against his racist accusers and blamed his employees for the fraud. He wrote endless screeds to Judge Shelby Highsmith. He was found guilty on all 40 counts in his indictment, and Highsmith sentenced him to 71 months in prison last February. He's doing time in Fort Dix, New Jersey. Reportedly, the ABC news magazine 20/20 is interested in documenting the saga.

THE LAND OF MILK AND MONEY
Francisco Leyva was an unemployed trucker without a lot of options when he met Frank Morfa. He had helped move some furniture for Morfa to earn a few bucks and he could see the prosperous businessman was the sort whose phone number he should keep handy. A couple of months later, in early 1990, Leyva called to see if Morfa might have a job available. "Just your luck," Morfa said.

The job consisted of overseeing a Hialeah warehouse full of canned milk products. Leyva also supervised a small fleet of drivers whose job it was to deliver the cans to elderly people all over Dade. The milk came in three flavors -- chocolate, strawberry, and vanilla -- and it was full of vitamins.

Leyva didn't understand much about the business, but he could see it was lucrative. Morfa and his various relatives were forever opening new companies and adding clients to his delivery list. Leyva even managed to get his wife and two stepsons hired to help. Sometimes the old people complained because they wanted strawberry rather than chocolate milk, or because they'd had enough milk and wanted delivery stopped. But just as often, they would invite him inside for some fried chicken and beer. Every two weeks Leyva got paid $500. He thought it was a pretty good job.

One day Leyva was helping to move some files into the warehouse when he happened to notice that one bore his mother's name. Inside was a typed form with his mother's name and address and a description of her physical condition. It listed her as weighing 106 pounds and suffering from "organic brain syndrome." His mother actually weighed more than 200 pounds, and her mind was so sharp that Leyva liked to joke that she could recite the last 600 episodes of her favorite telenovela. Leyva checked some more files of old people he knew from his deliveries and found the same sort of erroneous information.

Leyva had always suspected there was something fishy about the operation. Why, after all, would the government pay to have milk delivered to old people who were often perfectly healthy? An old woman he knew from his routes had said something about an investigator coming by to ask her questions. Not long after, Leyva was on the phone with the agent.

The call wound up being the key to unraveling one of the largest and most sophisticated Medicare frauds ever perpetrated. The infamous Morfa milk case cost the Medicare system an estimated $14 million. Before it was over, Morfa and ten other defendants, many of them his relatives, pleaded guilty. Another four were found guilty after a lengthy trial this past June.

The scheme was founded on an irresistible pitch to senior citizens: free milk from the government. All the viejitos had to do was hand over their Medicare account numbers.

Medicare will pay for recipients to receive fortified milk if the person in question can only be fed through a tube. Morfa simply paid doctors to sign forms stating that his clients had the necessary medical conditions. Dr. Mario Fonseca -- the man whose license hung on the wall at Gables Trauma Center -- was one of these doctors. Morfa also hired recruiters and paid them up to $100 to find new recipients.

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