Medicare corruption gusher worsens

By Carl Hiaasen
chiaasen@MiamiHerald.com

Among South Florida's fearless Medicare rip-offs -- and there are thousands -- is the story of Guillermo Denis Gonzalez.

After serving 14 years in prison for murdering a man with a silencer-equipped handgun, Gonzalez decided in 2006 to try the medical supply business.

For $18,000, the Hialeah resident bought a Medicare-licensed company called DG Medical Equipment and within a year he'd submitted $586,953 in false claims for supplies that were never provided to patients.

Medicare, using federal tax dollars, reimbursed Gonzalez $31,442 before he was tracked down and arrested.

Last summer, after pleading guilty to defrauding the government, Gonzalez was marched over to state court to face another murder charge -- this one for allegedly stabbing and dismembering an acquaintance during a monetary dispute. He is scheduled to go on trial next month.

No one familiar with Florida was surprised to learn that a murderer had been welcomed into the health-care trades. Indeed, the most shocking thing about the Gonzalez case was that Medicare hadn't forked over the full half-a-million bucks in bogus claims that he'd sought.

South Florida remains the Deepwater Horizon of Medicare corruption in the United States, and the gusher is getting worse. No other place even comes close to matching the number of crooked health-care businesses, or the immense dollar amounts that wind up in the pockets of criminals.

While overworked prosecutors crack down on operators like Gonzalez, the latest wave of Medicare cheats is specializing in fictional billing for mental health services, rehab sessions and physical therapy.

As Jay Weaver reported in The Miami Herald last week, mental health clinics in Florida billed Medicare for $421 million in 2009. That's four times more than was billed during the same period by mental health clinics in Texas, and 635 times more than was billed by clinics in Michigan.

As crazy and depressed as Floridians can be, there's no way that we're four times crazier than Texans, or 635 times more depressed than Michiganders.

The only plausible explanation for such a staggering discrepancy in mental-health claims is stealing -- thieves in Florida are simply more adept at fleecing Medicare.

Our dubious distinction as the sleazebag capital of America brought Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius to Miami last week for the first-ever national summit on healthcare fraud.

It wasn't quite as flashy or upbeat as the LeBron James-Chris Bosh-Dwyane Wade summit at the American Airlines Arena, but the mission is nonetheless worthy of attention.

Medicare is the biggest drain on the federal budget, and epidemic fraud is the biggest drain on Medicare. Most older Americans depend on the program to cover many health-care expenses, but the system is sagging and bloated.

Experts say Medicare fraud in South Florida costs U.S. taxpayers between $3 billion and $4 billion annually. It's predictable that Miami-Dade, Broward and Palm Beach counties would be the hotbed, and also the venue for one of every three federal healthcare fraud prosecutions.

Part of the problem is that Medicare pays claims first, then asks questions later. That leaves criminals with a time gap that often allows them to bank the money, shut down their storefronts and scurry on before they get caught.

In 2008, Medicare paid $520 million to home healthcare agencies in Miami-Dade, just for treating diabetic patients. That was more money than the agency spent on that particular illness throughout the rest of the country combined.

The feds then changed the rules and put a cap on claims for homebound patients receiving insulin injections. The scammers simply turned their energies toward other exploitable areas -- in particular, mental health and physical therapy treatments.

Records show that Florida rehabilitation facilities billed $171 million to Medicare last year for physical and occupational services, which was 23 times more than California and 26 times more than New York -- two other states with no shortage of fraud artists.

For years, the Justice Department has been locking up Medicare fraudsters in Florida, yet business is booming. More FBI agents and prosecutors would help, but you'd need an army of them to dismantle all the bogus Medicare operations in South Florida.

Despite all the individuals indicted, including 94 nationwide on Friday, the risk of getting nabbed for Medicare fraud remains relatively small, and the potential profits from the crime remain large.

That's why health-care is such an appealing career move for local felons, even the occasional murderer. Why use a gun when you can make lots more money with a pencil?

Read more: http://www.miamiherald.com/2010/07/17/1735272/medicare-corruption-gusher-worsens.html#ixzz0u38EiK5F

Comment

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