Tag Archives: Medicare

Why We Need To Pay Attention To Medicare Fraud

It is hard to imagine, but our seniors are being unwittingly used in a Medicare scam that is costing taxpayers billions. In fact, the numbers are staggering. Medicare fraud has numbered 27 billion over the last four years. The latest method, however, stoops to lows that most people never think about. Home medical supplies, scooters, wheel chairs, diabetic supplies and countless other materials are being billed under senior citizen’s names but they are never ordered or asked for.

These medical supply houses will hound a Medicare recipient sometimes up to three times a day to try to get their information or help. There are a ton of warning signals that jump out where these fraudulent companies are operating. Keep an eye out for:

  • Companies offering low or no deductible even though you know you generally owe one.
  • Companies offering a free scooter or wheelchair
  • Equipment being billed for you that you never receive
  • Companies that will not leave you alone even after you have asked them to do so
  • Something sounding too good to be true.

These are some good general guidelines but the key is to go with your gut. If you think something feels fishy, then check it out with your doctor or call the Medicare office at 1-800-MEDICARE and find out.

Many of these companies are being investigated and will soon be answering for some of these crimes. The fact is that there are some good companies that offer good services to our seniors. The key is that they need to be transparent. If a product is billed to Medicare and to the American people, then they need to make absolutely certain that it is legitimate. The government and the taxpayers deserve to know that is being followed.

If we continue to let these types of thing go, we will not even have Medicare when our kids are older. That is a risk we are already undertaking, but allowing things such as this to slide without stiff punishments are what forced us into this position in the first place.

Medicare fraud is a very serious issue and it needs to be addressed not only by Congress, but by the American people through information and our votes. If our representatives are not going to take this seriously, then perhaps we should change who we are voting for.

DaVita HealthCare Accused of Medicare Fraud: How to Protect Yourself from Healthcare Fraud

One of the biggest dialysis clinics in the US, DaVita HealthCare Partners Inc, is facing a lawsuit for allegedly over billing Medicare for as much as $800 million dollars. The lawsuit was filed by two men, Dr. Alon Vainer and Daniel Barbir, a nurse, who worked for the company. They claim that expensive medicine was being thrown out so the company could charge Medicare for more than was actually necessary.

Once a vial of medicine has been used to withdraw a dose, the bottle must be thrown away for health and safety reasons. What the doctor and nurse are claiming is that DaVita should be using smaller vials of the medicine so less is being wasted. The company is accused to over billing Medicare for as much as $800 million.

DaVita earns over two-thirds of its income from Medicare from its 2,000 dialysis clinics nationwide. Nonetheless, after investigating the allegations against the company, the federal government declined to pursue charges, although they stated that didn’t mean the company was innocent. If the two men win the case, they could receive millions of dollars, although the government would get the bulk of any judgment against the company.

How you can protect yourself from Medicare fraud

Medicare fraud is surprisingly common, and the government doesn’t have the resources to pursue every allegation, so they depend on whistleblower lawsuits like this one to catch companies defrauding the government. You can help protect your Medicare benefits from being abused to, although on a more personal level.

Steps you can take to prevent Medicare fraud Continue reading DaVita HealthCare Accused of Medicare Fraud: How to Protect Yourself from Healthcare Fraud

Fighting Identity Fraud: Government Steps up Battle against Medicare Fraud

The effort in preventing identity fraud has many components, and recently the government went more high-tech and stepped their battle up a notch in preventing Medicare fraud. They recently opened a $3.6 million command center that is said to potentially be a turning point in winning the war against Medicare fraud which is estimated to cost more than $60 billion annually.

Medicare fraud is something everyone should be concerned about. It doesn’t just hurt the government, but ultimately hurts all of us through higher taxes. Medicare fraud basically entails an intentional falsification or deception of information that involves Medicare. Just a few examples include false medical insurance claims, using another person’s Medicare information to obtain care or medical equipment, or billing for services that were not actually received by the patient.

Preventing identity fraud involving Medicare

Avoid becoming a victim of this type of identity fraud through the following:

  • Never give anyone your Medicare number other than your physician or Medicare provider. Think of your Medicare number in the same way you would your PIN numbers attached to a personal bank account.
  • Secure your medical records. Your records reveal the pertinent information a potential scam artist can use to perpetrate a crime. Keep medical records in a locked cabinet, and if they are on your computer make sure they are password protected.
  • If anyone comes to your door, or calls, in attempt to sell medical supplies or medications, never accept the offer no matter how legitimate it may seem.
  • If any medical practitioner or supplier offers items or services that you know are not usually covered by Medicare but claim that they can bill the expenses elsewhere, do not accept as this is most likely Medicare fraud.
  • Review your Medicare summaries or explanation of benefits carefully. Compare your services to what has been billed, and if you notice any discrepancies call Medicare.

Medicare fraud can lead to identity theft and potentially endanger lives Continue reading Fighting Identity Fraud: Government Steps up Battle against Medicare Fraud

Age does matter: Largest Medicare fraud case goes ‘easy’ on elderly

Approximately 18 months ago one of the biggest Medicare instances of medicare fraud was uncovered and over 94 people were arrested in Miami, Houston, Baton Rouge, Brooklyn and Detroit.  A grand total of $251 million was stolen from the medicare system in a series of incidents that included not completing medical testing or diagnostics that were billed,  home health care,  making false claims for treatment, medical equipment, physical therapy,  and other “goods and services” there were either never provided or were unnecessary.

(Talk about above and beyond reasonable and necessary charges).

Those arrested included senior citizens, doctors, and other medical care professionals.   Senior patiencts were offered a “kick back” of  $50-$100 for their assistance in this scheme where “suspects in Miami alone are accused of submitting $103 million in false claims, the Miami Herald reports. “This is like a game of whack a mole,” Miami U.S. Attorney Wifredo Ferrer told the paper. “The numbers are off the charts.”

How did the other cities and suspects “add” up?

According to ABC News:

  • In Baton Rouge, 31 defendants were charged for various schemes allegedly involving fraudulent claims for durable medical goods (such as wheelchairs) totaling approximately $32 million.
  • In Brooklyn, 22 defendants were charged for their alleged participation in schemes to submit fraudulent claims totaling approximately $78 million.
  • In Detroit, 11 defendants were charged for their alleged roles in schemes to submit $35 million.
  • In Houston, four defendants were also charged for their alleged roles in a $3 million

According to the US Dept. of Health and Human Services these

“arrests are a powerful warning to those who would try to defraud taxpayers and Medicare beneficiaries,” said HHS Secretary Sebelius.  “These arrests illustrate close cooperation between the Medicare program that identified these fraudsters and the law enforcement officials who acted swiftly to cut them off.  And our efforts to stop criminals don’t end here because the Affordable Care Act gives us new tools to prevent Medicare fraud before it is committed – better protecting seniors and the integrity of the Medicare program for generations to come.”

However, it seems that some defendant’s may be getting off “easy” as a deal is reached in the Brooklyn cases.  The New York Daily News reports, that 6 of the accused have reached a “deal.”  According the the Daily News “the indictment will be dismissed in 18 months if the defendants agree not to accept any more Medicare kickbacks and pay unspecified restitution. They do not have to admit wrongdoing before a judge.”

One defendant, at 76 years old passes away last summer due to natural causes.

This agreement is reached after one defendant appeared in the courtroom pushing a walked, and another at 84 years old didn’t appear because she couldn’t get a ride to the court.

Defense attorney John Kaley says. “We appreciate what we think is the government’s fair assessment of the case and it’s a just resolution.”

What do you think?  Should age and health issues be taken into consideration in a criminal trial?  Or should each of the defendants have to either plead guilty as three clinic operators (in the Brooklyn cases) or gone to trial, as two doctors in the Brooklyn case did?

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to:www.stopmedicarefraud.gov.


US Department of Health and Human Services 

CBS News 


ABC News 





Bad Medicine isn’t What I Need: Health Care Fraud’s Most Wanted List

Fast Facts and True Stories about Health Care Fraud

In 2008, Americans spent $2.34 trillion dollars on health care.  The Federal Bureau of Investigation (FBI) estimates that between 3 and 10 percent (between $70 billion and $234 billion) was lost to health care fraud.  $234 billion dollars is roughly the equivalent to the Gross Domestic Product of a nation the size of Columbia or Finland.

But the “costs” of these scams is not just measured in dollars and cents.  In June 2010, a doctor and his wife were convicted of running a “pill mill” that appeared to be a pain management practice in a Kansas.  The couple dispensed controlled prescription drugs; and collected more than $4 million from 93 different private health insurance and government health care programs.  The doctor was found to be responsible for more than 100 overdoses and at least 68 deaths over a six-year period.

Another organized health care fraud ring involved 5 states in pretend clinics and resulted in claims for approximately $110 million dollars in false claims.  In order for this “practice” to work the group also utilized identity theft techniques which allowed them to steal the identities of legitimate Medicare beneficiaries.  They were convicted in January 2010.

In Feb. 2011 FBI special agents broke up a health care fraud scheme in Puerto Rico and arrested approximately 200 of the 533 people named in the federal indictment. The scheme had been going on for years and involved false accidental injury claims made by policy holders and supported by certain doctors and medical professionals.

Feds Launch Most Wanted List for Health Care Fraud

Yes, it’s true the U.S. Department of Health and Human Services Office of Inspector General has launched a website with the 10 most wanted health care fraud criminals. These “fugitives” are accused of having cost tax payers over 124 million dollars in health care fraud.  However, they are actually seeking more than 170 fugitives on charges related to health care fraud and abuse.  The fugitive’s names, date of birth, descriptions and pictures are available on the website which is updated when they are apprehended.  You can even report a fugitive.

“We’re looking for new ways to press the issue of catching fugitives.  If someone walks into a bank and steals $3,000 or $4,000, it would be all over the newspaper. These people manage to do it from a less high profile position, but they still have a tremendous impact,” says,” said Gerald Roy, deputy inspector general for investigations at the Health and Human Services Department.

On the most wanted list:

Meet Leonard Nwafor; convicted of billing Medicare for more than $1million dollars for motorized wheelchairs that were not needed, one such “recipient” was blind.  Convicted of a federal crime and facing time in a penitentiary, he has disappeared.

Sisters Clara and Caridad Guilarte allegedly submitted $9 million to Medicare in false and fraudulent claims infusion drugs that were never administered, and offered rewards including cashing for those who agreed to visit their clinic in Michigan, and sign forms saying they received services which they didn’t.

Miami brothers Carlos, Luis and Jose Benitez were owners of a string of medical clinics.  They are accused of allegedly   “scamming” Medicaid out of out of $119 million by billing for costly HIV drugs that patients never received or did not need.

“Scammers often utilize their ties to a particular community. They take advantage of ethnic communities based on language barriers or lack of knowledge about how the Medicare system works. These folks are exploiting low-income communities,” says Gerald Roy, deputy inspector general for investigations at the Health and Human Services Department.

“With our Most Wanted Fugitives List, OIG is asking the public’s help in tracking down fugitives,” said Daniel Levinson, the HHS’ inspector general. “(It) has a stake in the fight against fraud, waste and abuse.”

Resources and Sources

Report a health care fraud fugitive

Ten most wanted list US Dept. of Health and Human Services OIG

National Health Care Fraud Association White Paper