Good congresswoman Jackson Lee again rode to the hospital's rescue. "Even if more harmful acts prove to be true," she wrote to CMS, "an entire institution should not be penalized by the acts of one person."

In Riverside's case, that "one person" would abruptly multiply. Khan ratted out CEO Earnest Gibson III as his co-conspirator. The feds also nabbed Gibson's 35-year-old son, Earnest IV. He ran one of the psychiatric clinics and was charged with billing nearly $700,000 for care that "was not medically necessary and, in some cases, not provided," according to prosecutors.

Investigators discovered that, since 2005, the hospital had been swindling the feds to the tune of $22 million a year. Khan pleaded guilty. The two Gibsons and five others await trial on charges of fraud, conspiracy, and money laundering.

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.

Jackson Lee refused to comment for this article.


Housed in a featureless building north of Miami, the HEAT Task Force is a government anomaly: It actually turns a profit.

For every dollar it spends investigating, it uncovers another $8 in fraud. Most agents work out on the street, assigned to about a dozen cases each.

In 2007, the government finally grasped the scope of all the stealing and got serious about trying to stop it. The Department of Justice launched Medicare Fraud Strike Forces in Miami and Los Angeles. Those were supplemented with HEAT teams (HEAT is short for the windy governmentese of Health Care Fraud Prevention and Enforcement Action Team) in 2009. This group — an interagency initiative combining members of the Justice Department and Health and Human Services — has branches in nine cities where the stealing is most prolific, such as Los Angeles, Houston, New York, Dallas, and Baton Rouge. Agents and prosecutors work in small, aggressive teams, combining data analysis with traditional detective work.

Since 2007, prosecutors have charged 1,480 defendants with $4.8 billion in fraud. More than half of those indictments came out of the unit in Miami, a city that Special Agent in Charge Christopher Dennis calls "the crown jewel of Medicare fraud." Miami was the MIT of health-care schemes, the nation's unofficial laboratory for ripping off the government. "A lot of the schemes are typically started here — vetted, proven here — and farmed out to other parts of the country," Dennis said.

At first, the Justice Department mostly tackled companies that sold medical equipment — scams involving wheelchairs, hospital beds, respiratory devices, and the like. Lax oversight allowed these businesses to pop up overnight, bill Medicare for hundreds of thousands of dollars, then disappear just as quickly — only to reemerge elsewhere under a new name. Often, perpetrators had fled the country with the stolen funds before indictments could come down.

Hank Walther was a federal prosecutor who led the feds' Medicare Fraud Task Force. He feels they were allowing their adversaries to run scot-free.

"My 4-year-old kid could prosecute these cases," he says of the equipment rackets. "They're really easy, and there are plenty of them. A lot of this other stuff — home health, the ambulatory cases, even the mental-health cases — each time we got into those new areas, there was a constant refrain from law enforcement and the U.S. Attorney's Office saying, 'This is too complicated.'"

The feds started teaming prosecutors with detectives in the same approach used to break down organized crime. They began to hunt providers, whose fraud ran to the tens of millions compared with the $1 million to $2 million paydays from equipment scams.

"When you look per capita, Miami has more people in community mental-health centers than New York and Los Angeles combined," says Walther. "Then you look at the profile of people going in there, and they don't really fit people that need these services."

In 2010, Walther helped take down American Therapeutic, the highest-billing mental-health center in the country. The company was cycling addicts, alcoholics, and Alzheimer's patients through its six clinics. Patients' diagnoses were changed so they would qualify for expensive group therapy. In the end, owner Lawrence Duran received an unheard-of 50 years, a sign that judges were finally acknowledging the magnitude of these swindles.

"It's like Whac-A-Mole," says Walther. "You knock one down, but now there's a bigger one somewhere else, and it's different. But once you figure it out, it rains on the back end with bad guys and money."

HEAT Agent Reginald France, a first-generation Haitian-American built like a linebacker, was out at 3 a.m. recently raiding a medical office. His motivation comes from the guile of these crimes.

"You have some of the smartest people in law enforcement working here," he says. "In a lot of ways, that drives us, because we want you to understand you can't pull the wool over our eyes."

Elderly Medicare recipients are crucial to the schemes. Instead of stealing patients' Medicare numbers, which are needed to submit invoices to Medicare, frauds pay the elderly in kickbacks. Recruiters typically pay beneficiaries a combination of cigarettes, booze, pills, and money. Cash payments can reach $2,000 quarterly. All recipients have to do is sign sheets confirming that care was received.

For the patient, it's a low-risk play. Nobody wants to put an 80-year-old meemaw in front of a jury. Prosecutors wouldn't recoup much even if they did. And since by law Medicare can't be revoked, there's little downside to bartering your number away for a carton of Kools.

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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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