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