MIAMI — Elderly Russian immigrants lined up to take kickbacks from the backroom of a Brooklyn clinic. Claims flooded in from Miami for HIV treatments that never occurred. One professional patient was named in nearly 4,000 false Medicare claims.
Authorities said busts carried out this week in Miami, New York City, Detroit, Houston and Baton Rouge, La., constituted the largest Medicare-fraud takedown in history — part of a massive overhaul in the way federal officials are preventing and prosecuting the crimes. In all, 94 people, including several doctors and nurses, were charged Friday in scams totaling $251 million.
Federal authorities, while touting the operation, cautioned that the cases represent only a fraction of the estimated $60 billion to $90 billion in Medicare fraud absorbed by taxpayers each year.
For the first time, federal officials have the power to overhaul the system under President Barack Obama’s Affordable Care Act, which gives them authority to stop paying a provider they suspect is fraudulent.
Critics have complained the current process did nothing more than rubber-stamp payments to fraudulent providers.
“That world is coming to an end,” Health and Human Services Secretary Kathleen Sebelius said after speaking at a health care fraud prevention summit in Miami. “We’ve got new ways to go after folks that we’ve never had before.”
Officials said they chose Miami because it is ground zero for Medicare fraud, generating roughly $3 billion a year. Authorities indicted 33 suspects in the Miami area accused of charging Medicare for about $140 million in scams.
Cleaning up Medicare fraud will be key to paying for Obama’s health care overhaul. Federal officials have allocated more money and staffing to fight fraud. So far, the operations are responsible for more than 720 indictments that collectively billed Medicare more than $1.6 billion.
Some of the schemes
Patient kickbacks: In a $72 million scam at Bay Medical in Brooklyn, N.Y., clinic owners submitted bogus physical therapy claims for elderly Russian immigrants. Patients, including undercover agents, were paid $50 to $100 a visit in exchange for using their Medicare numbers.
Numbers shopped: In a separate Brooklyn case, authorities charged six patients who shopped their Medicare numbers to clinics. More than 3,744 claims were submitted on behalf of one woman alone, 82-year-old Valentina Mushinskaya, over the past six years.
