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


US Department of Health and Human Services 

CBS News 


ABC News