Oct 26, 2009 6:32 pm US/Eastern
I-Team Uncovers Billions Lost To Medicare Fraud
MIAMI (CBS News) ―
-
-
The CBS4 I-Team partnered with 60 Minutes for a joint investigation into Medicare fraud here in South Florida. It's a crime that costs you, the taxpayer, more than $60 billion a year!
CBS News
The
CBS4 I-Team partnered with
60 Minutes for a joint investigation into Medicare fraud here in South Florida.
It's a crime that costs you, the taxpayer, more than $60 billion a year!
CBS4 I-Team Investigator Stephen Stock went undercover with other I-Team member to find suspect medical clinics operating in South Florida one step ahead of the law.
The grainy, shaky undercover video tape shot by the
CBS4 I-Team shows dozens of different medical clinics located in the Miami area. They are clinics where federal agents suspect questionable Medicare billing practices are taking place.
Much of the conversation on the videotape is in Spanish. But the bottom line is in a language everyone understands -- money.
A
CBS4 staffer asks one office manager "So how much would you give me (for this list of Medicare patients)?"
The unidentified office manager replies: "In reality we get $800. And I get half and you get half."
Federal investigators say the ease with which
CBS4's I-Team was able to make these financial arrangements shows that what was once the cocaine corridor has now become the Medicare Fraud frontier.
"Health care is a national problem and what a lot of people don't know is that South Florida is ground zero," said Omar Perez, Special Agent for the US Department of Health and Human Services' Office of Inspector General's Office of Inspections.
"It's where (Medicare fraud) is developed, where it's tested, and once it's proven shipped out to other parts of the country," said Perez.
"It was that easy!" said an unidentified Medicare patient. "All you had to have was a Medicare card."
The patient used to get paid to just sign a name and show a Medicare number.
After four years of getting paid to fraudulently bill, Medicare law enforcement finally caught up with the patient. That's why the patient now serves as an undercover informant for the FBI.
"Once you put your signature down there, bam! You get your money," said the FBI informant.
Here's how federal investigators say the Medicare scam works: local medical clinics pay recruiters to bring groups of Medicare patients and their numbers to the clinic.
But the patients don't get any real medical treatment.
And instead of paying the doctor, the doctor or medical clinic pays them!
Then the clinics bill Medicare tens of thousands of dollars for services not needed and in most cases they are services which are not delivered.
"If you're getting a $100 from one place you're getting $200 from another place," said the FBI informant. "We averaged about $700 to $900 a day every Monday, Wednesday, Friday (for years)."
Frustrating federal investigators even more, many of the medical supply storefronts stay open only long enough to get a Medicare number. Investigators say once the storefronts get their Medicare billing number they then start billing the federal government without delivering anything. They close up shop and keep billing by mail making the storefronts nearly impossible to catch.
By law, Medicare must pay out money for the bills within 15 to 30 days of the claims being filed. By the time the FBI or even some Medicare patients notice, it's too late, the money has already been paid and the storefront operations have moved on.
In fact, the
CBS4 I-Team visited seven different medical clinics federal investigators were closing in on but found them closed. Many of these supposed clinics were located off the beaten path in warehouses or hidden office complexes.
One supposed medical supply company even operated out of a storage facility, not the kind of place where you'd expect to find legitimate medical services.
When the
CBS4 I-Team visited these locations, all of these supposed clinics or medical supply stores had closed their doors and moved on just steps ahead of federal investigators who'd planned to move in to shut them down.
"As soon as they've gotten their Medicare provider number they close up (and keep billing Medicare by mail)," said HHS investigator Omar Perez. "It's that fast."
I-Team investigator Stephen Stock asked incredulously "Really it's that fast?"
"It's that fast," replied Perez.
"In fact, the notion of having a storefront really doesn't exist anymore," said Perez. "You don't need it. You set up shop and Medicare comes out and they inspect you, get your provider number and then (you) close shop (and submit bills),"
Perez explained how the scheme has worked in the past.
"We've learned there are individuals where it is their practice that they get called up and say 'Hey, I'm setting up a durable medical equipment company,'" said Perez.
"'I'll set up shop then when you get your provider number, I come and pick up the equipment and set it up someplace else and you'll pay me' (to set up the fake storefront shop)," Perez said describing how the scam sometimes works.
Just since August, 2009, the
CBS4 I-Team has tallied more than a dozen people who have been arrested and charged or convicted of stealing nearly a half billion dollars total through Medicare fraud in Miami-Dade County alone.
If you have a tip or know of someone who might be committing Medicare fraud there's a new special hotline set up for you to call:
1-800-447-8477 (
1-800-HHS-TIPS).
Coming up Sunday, November 1, 2009, the
CBS4 I-Team will take an even more in-depth look into Medicare fraud.
It's all part of a
CBS4 News special report:
"The I-Team investigates."
That's Sunday, November 1, 2009, at 6:30 p.m. on CBS4.
(© MMX, CBS Broadcasting Inc. All Rights Reserved.)
Click to enlarge
Stumble It!
Reporting
Comments