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Nov 5, 2009 11:27 pm US/Eastern
I-Team: Biometrics May Fix Medicare Fraud Problems
MIAMI (CBS4) ―
Now to a CBS4 I-Team investigation into the theft of billions of your tax dollars.
Medicare fraud costs each of us nearly $200 for every man, woman and child in the United States in stolen tax dollars every year.
And a CBS4 I-Team investigation uncovered how South Florida is at the center of Medicare fraud.
Now, a Broward County entrepreneur says he may have a solution in a high-tech biometrics device that would guarantee Medicare doesn't pay for phantom patients.
CBS4 I-Team investigator Stephen Stock looked into the technology that might save taxpayers millions.
Tens of millions of tourists visiting Walt Disney World use it every year.
Since 1995, visitors going to see Mickey Mouse have used high tech, biometrics, or fingerprint scans to enter the park and ensure only one person uses each annual passes or tickets.
Now, a South Florida man says he's developed computer software to use that same technology to stop Medicare fraud.
"When you go, biometrics is essentially your body's password," said Deerfield Beach civil attorney Scott Kimmel.
Scott Kimmel has set up a company called Biometric Technologies, Inc. which has patented unique software specifically to use biometrics technology to cut down on Medicare fraud.
"When you go into a doctor's office, you currently sign in with a pen," said Kimmel. "Using this technology with us with us you would actually use a finger print or biometric technology (to sign in.)"
In a four month long undercover investigation, the CBS4 I-TEAM demonstrated how easy it is to buy and sell Medicare numbers to commit fraud.
Federal authorities say Medicare is a major problem in South Florida. In fact, they consider South Florida the epicenter of Medicare fraud around the country.
"So they give you the amount and us the amount," says a local clinic's office manager in Spanish on undercover videotape. "They give $800 or $900 and you give to the person what you want."
The undercover video shot by the CBS4 I-Team using an undercover photographer shows a discussion about an exchange of a list of people and their Medicare numbers.
The woman talking in Spanish is the office manager at a local medical clinic.
"They give 800 per person," says the office manager describing how much each patient would get for attending the clinic.
Within minutes the office manager is talking money with our undercover photographer.
"In reality we get 800 and I get half and you get half," the office manager says on the undercover tape in Spanish.
Other parts of the conversation show that the manager is telling the photographer that she'll split $200 for each Medicare patient he brings in.
"And they can do only the x-ray," the office manager says.
That means that all the clinic will do for the patient whose name they have is give them an X-ray, no medicine or actual medical services. But the office manager will bill Medicare for much more than just an x-ray.
"And you can sell those people (to other clinics) and then in three months they can come back (and bill them again)," the office manager tells CBS4's undercover photographer.
In many cases, federal investigators say, the patient doesn't even have to show up. Federal authorities say that just about all a clinic really needs to bill Medicare is a name and number.
"In one month $800 for the patient, you $100, me $100, okay," said the CBS4 undercover photographer to the medical clinic office manager.
"Once you have a patient name, social security number and address," said FBI agent and lead Medicare fraud investigator Brian Waterman. "You simply go to a C-P-T code book and in that book there are lists thousands of different codes that you can bill for and Medicare simply can't monitor all these codes."
Investigators say after these clinics pay for these lists of numbers they then bill Medicare tens of thousands of dollars for drugs, medical equipment and supplies that aren't needed and in most cases never even delivered.
Scott Kimmel says biometrics can help cut down on that in a big way.
"(Using Biometrics technology) this way doctors can't get paid for patients that never physically enter the office," said Kimmel.
Scott Kimmel says the unique software which he and his team designed and patented can help eliminate this phantom billing.
"By guaranteeing that patient is physically present it eliminates the phantom billing fraud which is probably one of the largest types of fraud perpetrated," Kimmel said.
Kimmell says his biometrics scanner is already being used by some private medical providers in Tampa.
Federal officials in Washington say this idea has merit and they're seriously considering it.
"As a tool of detection I think it certainly is a good tool," said Christopher Dennis of the US Health and Human Service's Office of Inspector General's office of Investigations. "I think it would work."
Dennis is the Special Agent in Charge of the office of investigations at the Office of Inspector General at the US Department of Health and Human Services based in South Florida.
The Department of Health and Human Services administers and oversees Medicare.
Dennis says Biometrics would help stop Medicare fraud. But he also says the technology would only go so far in stopping this fraud.
"What it would not deter is that same person (with the fingerprint) seeing the provider or doctor and (it would not prevent them) being billed for services that are not rendered," said Dennis.
"That same doctor might add on durable medical equipment such as wheelchairs, or bill screenings (such) as for cholesterol that are not rendered to that patient at that time," said Dennis.
And, Dennis said, it is likely that biometrics technology would not stop that type of fraud.
But federal officials say biometrics is already being used in Texas to help reduce Medicaid fraud.
The US Government has established a hotline devoted to nothing but taking tips from the public about Medicare fraud.
You can call the hotline at number is 1-800-HHS-TIPS (1-800-447-8477.)
(© MMIX, CBS Broadcasting Inc. All Rights Reserved.)
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