South Florida Is Ground Zero for Medicare Fraud

South Florida Is Ground Zero for Medicare Fraud
Ellen Weinstein

Driving through Hialeah, where strip malls line boulevards like concrete-and-metal kudzu, a federal agent offers a reporter $1 for every strip mall he can spot that doesn't house a medical business.

Let's just say the reporter is still broke.

In this city, streets are a jumble of doctors' offices, physical therapy programs, adult daycares, and mental-health clinics stretching in every direction. Mom-and-pop pharmacies proliferate despite being situated doors down from Walgreens.

Gov. Rick Scott was CEO of a hospital company nailed with two sets of books. Then he went into politics.
Gage Skidmore
Gov. Rick Scott was CEO of a hospital company nailed with two sets of books. Then he went into politics.
Christopher Dennis and Reginald France work out of the Miami-area HEAT task force office.
Liliana Mora
Christopher Dennis and Reginald France work out of the Miami-area HEAT task force office.

Agents say — and prosecutions prove — that something suspicious is going on. Many of these businesses provide no therapy, unnecessary therapy, or dubious therapy, then turn around and bill federal taxpayers for this "health care" through the Medicare program.

"They bring in these Zumba dancers," the agent cracks. "These young girls are Zumba-dancing away, and these old guys are looking at it, and, yeah, they're getting some kind of therapy."

Medicare fraud threatens to overtake drug dealing as America's favorite get-rich-quick pastime. The stealing has become so sweet that street criminals can easily pull in $25,000 a day without carrying a gun. Because the crime is so widespread, prosecutors don't even bother going after anyone unless they've stolen $500,000 or more. The few who are caught and convicted typically get only modest sentences, making Medicare fraud the criminal equivalent of saccharine.

Think of the Medicare program as a bank that never bothered to buy a safe.

When the program was established in 1965, it was set up to provide medical care to people over age 65 who typically could not afford private insurance. But founders of the program did not anticipate the changes that were to come — population booms, skyrocketing medical costs, prescription drugs, private insurers shunting unhealthy people. Nor did they anticipate the thieves of today.

In the idealistic 1960s, people generally knew their virtuous family doctor, and health-care fraud was such a secondary concern that Medicare fraud wasn't even officially made a crime until 1996. In the intervening decades, things changed.

First, some doctors were loath to accept Medicare patients because they didn't want to wait for the wheels of bureaucracy to churn; it was weeks before they'd receive checks in the mail for services rendered. So Medicare, looking out for its elderly patients, made it easier for them to receive care by approving more providers. The program made it simple for anyone who wanted to open an outpatient clinic or a medical supply company to get a Medicare provider number (technically, a ten-digit National Provider Identifier, or NPI) — the green light to start doing business. With this number, providers could start serving Medicare patients, then submit invoices to and get paid by the government. Many providers — like the ones that sold medical equipment, for instance — didn't need licenses, and there were no education requirements. Medicare started direct-depositing payments in doctors', hospitals', and providers' accounts almost as soon as bills were submitted. Before long, the tables were turned and health-care workers were clamoring to get those Medicare patients in the door — and receive the steady payments. Uncle Sam's checks never bounced.

Medicare's good intentions were exploited in a multitude of ways by a wide array of thieves, as detailed in this article. Because Medicare has traditionally paid invoices first and pursued criminals only after time-consuming audits ("pay and chase," insiders call it), the U.S. Treasury has bled like a hemophiliac — and South Florida is the gaping wound. In the past 20 years, everyone from HMOs to drug dealers has been caught robbing the program time and time again, stealing the kind of money that makes the sequester look like pocket change.

Given how often such blatant thievery goes undetected, no one's sure how much fraud there really is. Conservative estimates place the bill at $100 billion annually. The more adventurous peg the figure closer to $300 billion — three times what the feds spend on education. It has left federal health care little more than an unlocked home, where street punks and gangsters, doctors, and even states walk right in and help themselves to whatever's inside.

Though the government is finally making inroads into stopping this fraud with special teams of investigators and prosecutors, the federal agent driving through Hialeah says he's been working on health-care fraud for ten years — and he's sure he'll be working on it for ten more.


Warm weather attracts mold, mosquitoes, and retirees with government benefits. With the senior population conveniently warehoused in group homes and assisted-living facilities, it's no surprise that South Florida is the epicenter of health-care fraud. The examples are legion.

Let's start with Cuban expat Armando Gonzalez, who served five years for dealing crack. When he got out, he applied for and received a Medicare provider number and — ka-ching! — opened several outpatient psychiatric clinics in Miami.

Gonzalez teamed up with assisted-living facilities full of residents suffering from retardation and dementia. In exchange for kickbacks, operators of these facilities would bus in all their patients; Gonzalez would collect each of their individual Medicare card numbers and bill Medicare for services the "patients" weren't eligible for or never received.

By the time the feds started sniffing around in 2008, Gonzalez had made off with $28 million, enough to fund a personal fleet of 17 luxury vehicles. He closed shop in Miami only to reopen in North Carolina. When he was finally arrested last year, Gonzalez was planning to expand into Tennessee. He pleaded guilty in December.

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17 comments
adela_juliana
adela_juliana

For prescription drugs we go to the Cuban doctors

for coke pot  crack and bath salt  we go to the hood

for meth we go to our local white trash  trailer parks

limpindrummer
limpindrummer

It's ironic that the same republican cubans, who make their living stealing from Medicare, vote for incompetent, corrupt, republican, politicians (cuban or not), who seek to abolish Medicare.  I'll go out on a limb and guess that they're still in business because they're greasing the republican cuban law enforcement personnel who are supposed to be investigating them.  Okay, not that much of a limb!

But, none of that is as ironic or as funny as their dim witted, republican, teabagger, counterparts who show up at teabagger rallies with signs that declaim: "KEEP GOVERNMENT OUT OF MY MEDICARE." 

moalta
moalta

Wow... you American especially in Florida amaze we Canadians.  Glad to see your problems with Cuban ripoff artists ... it's the least you deserve in payment for your stupid policies about Cuba.  We Canadians, and the rest of the world, actually recognize Cuba's independence and treat Cuban immigrants equally with other countries, thus avoiding acceptance of scumbags which you seem to welcome in Florida.  More importantly, we and all of western Europe have publicly administered and funded healthcare (hospital, doctor and lab services) and avoid the "for profit" high costs and ripoffs you Americans withstand.  By keeping these services private in the US, you deserve the inevitable high costs and ripoffs that will occur.  Ain't American values (capitalism and guns at any cost!) great!  Sorry to be arrogant but the US seems overly populated with right-wing yahoos and their blind followers.

goces1
goces1

Even Fidel Castro is in on this....Several Cuban nationals have come here to rake millions to Cuba's banks for the dictators.

stephenwnwrght84
stephenwnwrght84

These Jackasses make Florida look bad. And make it worse for the really sick & Disabled people living in Florida Hell Even Governor Rick Scott Got fined for this.before he was Elected governor. We need a new Governor. I miss Charlie Crist & im a Democrat

internetinternet
internetinternet

Flood insurance, mortgages, condominiums, and auto insurance.  Revolving door of fraud.  Welcome. 

run.randrand
run.randrand

SO BAND TOGETHER A MOB FIGHTING CREW LIKE ELLIOT NESS'S "UNTOUCHABLES", BACK IN THE PROHIBITION DAYS...!!!!!

Palangana
Palangana topcommenter

"South Florida Is Ground Zero for Medicare Fraud"


You don't say.

drakemallard
drakemallard topcommenter


cuban medicare fraud and marco rubio is silent about

 South Florida is known as the capital of Medicare fraud,

Feds in Miami: Millions stolen from Medicare wound up in Cuban banking system In an unprecedented case, federal prosecutors have charged a Miami man with engaging in a massive money laundering scheme that moved millions stolen from the federal Medicare program into Cuban banks.

limpindrummer
limpindrummer

You sound like you've been paying too much attention to reality.  Don't you understand that real Americans watch Fox News and parrot corporate fascist talking points as if they were actually true? 

Exiliado
Exiliado topcommenter

@moalta I would argue with you, especially about why and how it is immoral to recognize the dictatorship currently oppressing Cuba, but when you call those with a different opinion "stupid", "right-wing yahoo" or "blind", you simply disqualify yourself. You, or your opinions, cannot be taken seriously due to your admitted arrogance and your lack of respect or tolerance for differing opinions.

305carolann
305carolann

@moalta Very easy for you to say... how many Cubans do you have living in YOUR neighborhood.  Any Botincas around?  Maybe some severed goat heads.  Don't get me started on Canada... how about you go bash some harp seals skulls in?  Or better yet, look up your local sexual predator - oh, that's right YOU CAN'T because that isn't public info there.  Your medicine is not nearly as good as ours here in America - that is a fact, look up the statistics.  Do you know how many freaking Quebec license plates I see daily? If the USA is soooooo bad why the fuck are there thousands of Canadians on MY beach with fat guts hanging over their speedos? 

adela_juliana
adela_juliana

@drakemallard 

Cuban banks?

FYI Cubans here and abroud put our money in the Netherlands like Mitt  Romney, Cuba does business with all the countries in the world ---not the USA====

run.randrand
run.randrand

@drakemallard .....ehhh? They do more then take days off, lie as politicians, eat black beans and slog down sweet, strong coffee in little cups??! Whoddathunkit???!

limpindrummer
limpindrummer

You are employing a strawman.  Moalta did not call "those with a different opinion," stupid, blind, etc.  It is quite clear from her/his post that he/she is referring to those with a very specific opinion: who support capitalist medicine, not the open ended false premise: "those with a different opinion," that you have tried to divert the argument with. 

moalta
moalta

@305carolann @moalta We Canadians go to Florida, Mexico and CUBA (700,000 to Cuba last year!) because it is warm.  More Americans by far die from lack of proper medical care than do Canadians because our doctor and hospital services are available for everyone without direct charges. It is also more efficient ... the cost of administering your private services and private insurance companies is the highest in the world.  It is foolish and stupid and the rest of the world knows it.  Enjoy your blissful ignorance.

 
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