PROTECTING
PATIENTS FROM HEALTH CARE FRAUDSTERS
10 Indicted on Medicare
Fraud Scheme
07/26/04
"Whoever
talks here may put me behind bars, but when I get out, that person will
no longer be here on this earth."
One of
10 individuals indicted by federal authorities last month in Puerto Rico
as part of a major health-care fraud scheme uttered this phrase to intimidate
workers at a San Juan durable medical equipment company under federal investigation,
according to the recent indictment. But threats like that didn't stop investigators
from uncovering the truth.
What
was the scheme? Owners of Melendez Medical Equipment (MME) paid independent
sales representatives (who of course were "off the books")
a nice kickback to push Medicare-covered equipment on unsuspecting victims.
The company then submitted Medicare claims for the wheelchairs with fraudulent
physician signatures to collect large reimbursements.
Why
motorized wheelchairs? Because big profits make the motorized wheelchair
a high fraud item. Companies like MME who buy in bulk can make thousands
of dollars in profit on the chairs in Medicare reimbursement. The more
chairs they sell, the more money they make.
How
did they find customers? Illegally, of course. The reps would buy
confidential patient information from medical facilities, then literally
show up at a patient's doorstep claiming their equipment will help the
person's medical condition. And a number of doctors, including one with
a suspended medical license, reportedly received kickbacks for either
referring patients to the reps, or for unlawfully signing a certificate
of medical necessity after patients' primary physicians refused to sign
one.
Who
alerted the feds? An on-the-ball CMS (Centers for Medicare and Medicaid
Services) contractor, Palmetto GBA, charged with overseeing Medicare
durable medical equipment claims discovered that MME had jumped from
1882nd to 358th place nationwide in motorized wheelchair billings within
four short months--and had become the top supplier in Puerto Rico in
the process. Definitely a red flag.
The FBI,
along with its fellow law enforcement partners--the Health and Human Services
Office of the Inspector General (HHS-OIG) and the U.S. Postal Inspection
Service--was soon on the case to get to the bottom of this fraud. So far,
the two MME owner/operators, along with eight former MME independent sales
reps have been indicted on multiple counts related to this Medicare kickback
scheme. And CMS has suspended Medicare reimbursements to MME.
How
prevalent is this fraud? Government health programs, like Medicare
and Medicaid, are a favorite of health care scammers and account for
some 44 percent of all health care fraud. Losses total more than $100
billion annually.
How
can the public help? If you have any information relating to health
care fraud, contact your local FBI Office and speak to a Health Care
Fraud Supervisor. You may also call the HHS-OIG hotline at 1-800-HHS-TIPS.
