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Wayne, 62 years old and exuding a wry world-weariness, scowls as a red Dodge pickup truck pulls to the curb a half-block to the east along NW 54th Street. Immediately two men approach the cab, one to each window, converse with the driver, and walk back toward the pay phone. For most of the day this truck and other vehicles will come and go, dropping off patients, picking up others. Law enforcement officials refer to these drivers as "unlicensed brokers," the next step up the criminal ladder from the street sellers. AIDS patients generally call them middlemen or runners (although runners more often steer patients to middlemen). The brokers buy the meds and/or the prescriptions, then sell them either to a bigger broker, a pharmacist, or a pharmaceutical wholesaler.
Wayne drains the beer bottle. Beneath the brim of his black cap, his eyes droop almost mournfully, but it's impossible to read any emotion in them, only that bleary look produced by freshly smoked crack and marijuana. "I need tires on my car," he announces more to himself than to any bystander. "And I got $20. I gotta live. I gotta survive." Someone calls to him from the clinic waiting room, and he rushes toward the door, his striped shirttail flying. "I'll be out in ten minutes," he mutters.
He emerges with a month's supply of prescriptions for the newest AIDS medications, called protease inhibitors, that must be taken in conjunction with each other. "They call it a cocktail," Wayne says unhappily, as if trying to deny the permanence of the virus that has defined his existence for what seems like several lifetimes. He won't reveal the names of the medicines he's supposed to take, but he has no problem explaining why he's not going to take them. "Never proven that they work," he insists. "Unless I'm dying in the hospital and they give me something and it saves my life, you can't convince me it works." He sidles over to the darkened driver's-side window of a white sedan parked at the curb. After a quick conversation, Wayne frowns and shakes his head. "His ass don't have enough money," he says a few minutes later, gesturing with his goateed chin toward the white car. Then he notices that the red pickup is back, having driven away and returned to let off a woman and her baby at the clinic. Wayne moves to speak with the pickup driver, a white man sporting a shaved head and gold chains.
He climbs into the cab and they drive to a pharmacy in Allapattah, where Wayne legally fills one of his prescriptions, likely for pain pills such as the popular Percocet, though he won't say. The driver then buys the bottle from him (going rate: $2.25 to $2.40 per pill) and returns him to the clinic.
The routine is not unique to the Metro-Dade Medical Center. Many patients visit as many different doctors at as many different offices as they can. Wayne, for example, is a client here and at Specialty Medical Care Center at 1313 NW 36th St., another clinic catering to indigent patients. Each time he sees a doctor he receives prescriptions, and each time he walks out he can convert his medicine to money in a variety of ways, from a quick sale to a man in a car to the more profitable encounter with a buyer in a pharmacy or even in the comfort of his own home. (Most buyers make house calls and provide transportation to a pharmacy if necessary.)
A half-hour later, now with a bagged can of Schlitz malt liquor in his hand, Wayne catches a ride to Overtown with three of the people who've been waiting around the Metro-Dade clinic. They stop at Viko Drug Store at 1490 NW Third Ave., where they plan to exchange their prescriptions for green-and-white bills. Not just anyone can do this; it's referral only. Today the pharmacy is busy, so busy Wayne reports that the pharmacist is running short of cash and can offer him only half the $200 he expects for his prescriptions. So he takes $100 with the proviso he'll return the next day for the balance. (Viko's owner and pharmacist, Victor Osagie, says he is unaware that his small store is one of several pharmacies named by AIDS patients as a place to sell prescriptions. "I fill prescriptions," Osagie insists. "I don't buy them. Who was it who told you this?")
Total Medicaid expenditures in Florida are $6.5 billion annually. Miami-Dade County is home to about 24 percent of the state's 1.4 million Medicaid recipients. This year the program will spend $1.1 billion on pharmaceuticals throughout Florida, according to Jerry Wells, pharmacy program manager for the state Agency for Health Care Administration, which administers Medicaid in Florida. Of the total pharmaceutical budget, $130 million will go to HIV medications, a fourteen percent increase over last year.
Wells estimates that an astounding $50 million to $100 million per year in Medicaid reimbursements result from fraudulent claims, though there are no figures for fraud involving AIDS drugs specifically. (Medicaid is separate from Medicare, a federal health program for the elderly and disabled.)
"The general public has no conception of what goes on," declares Rocco De Leo, Miami bureau chief of the state attorney general's Medicaid fraud-control unit. The black-market demand for all kinds of prescription drugs, from sedatives and pain pills to expensive blood-pressure and depression medications, is seemingly insatiable. Cesar Arias, a drug agent supervisor for the state Department of Health, oversaw several of the reverse-sting operations in Little Havana that led to the recent arrests. Arias repeatedly gave a handful of informants money to buy medicine to resell to pharmacists. The informants were either agents posing as brokers or were actual brokers who had been arrested and had agreed to cooperate with the state. Numerous transactions were captured on a hidden camera carried by an informant's associate. "In three months I bought $25,000 worth of pharmaceuticals from brokers," Arias recalls. "We sold them [to pharmacists] for at least three times that. And we could have bought more if we had more money."