"That's the bread and butter of the fraudster — the fact he can pay somebody to participate in the scheme," says Dennis. "If you have a willing participant, you then eliminate the ability to tie the fraud to you. That person is going to lie for you because they conspired with you."


"All of these prosecutions are great," says Louis Saccoccio, CEO of the National Health Care Anti-Fraud Association. "We have strike forces, but the prosecutions just tell you we have a big problem, because that means the money's already out the door. So the focus now is starting to shift to prevention."

President Obama has expanded the task forces and made fighting fraud a pillar of the Affordable Care Act, otherwise known as Obamacare. CMS was given greater discretion in suspending payments and screening providers before they entered the system. Penalties and prison time were also increased.

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.

But excuse congressman Michael Burgess' skepticism. The Tea Party Republican from Texas has heard such talk before.

The former gynecologist is willing to concede that progress has been made. Yet the sheer size of the task makes crime-fighting difficult. Every day, Medicare contractors process 4.5 million claims. Even Republicans admit that CMS is undermanned and forced to rely on contractors, whose ferreting out of fraud is inconsistent at best.

"There was a famous case here in Dallas where a Nigerian woman had been busted," Burgess says. "As she was going off to jail, it was discovered that she had several other provider numbers. They discovered that she was receiving checks at the same post office box. It never occurred to anyone that, 'Hey, anything that goes to P.O. Box 9058, that's a red flag.' We were probably paying for her defense."

In New York, centers for people with mental issues were charging the feds $5,000 per day per patient. Arizona, by comparison, charges $200 a day. The reimbursements were based on a changing formula that CMS kept approving even as payments skyrocketed. New York's estimated overcharges: $15 billion. Even though CMS discovered the state's gouging, six years later it's still negotiating a remedy. CMS now plans to let New York phase out its overbilling, essentially allowing the state to steal a little less each month. (CMS officials declined to be interviewed for this article.)

More obvious improvements still elude the agency — even such basics as changing a beneficiary's Medicare number when theirs is stolen or used in a fraud. Others wonder why CMS hasn't mimicked credit-card companies, which flag suspicious behavior within minutes.

"I sent my staffer to Chick-fil-A with my personal credit card to charge $100 of sandwiches for our office for lunch," says Burgess. "So I'm called off the floor of the House to answer a phone call from my credit-card company saying, 'Hey, someone is trying to charge $100 worth of sandwiches.' Why can't [Medicare] do that?"

Obamacare has allocated $100 million to CMS to create a similar computer system that would employ data analytics to flag suspicious claims as soon as they're billed. The new proactive stance includes a spiffy command center in Baltimore linked to field agents. In its first full year, the system identified or prevented $115 million in fraud.

But as Burgess notes, Obamacare provided CMS with "seven new tools" to fight fraud. Four years after the law passed, CMS has managed to enact just one.

"At this rate, some point before my natural death, maybe we'll have done half of them," says the congressman.

Though most everyone agrees that the government is moving in the right direction, $100 billion continues to walk out the door each year.

"This is a lucrative business, and business is good," says Feinwachs. "The only problem is that you and I are funding it."

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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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