By Alan Prendergast
By Michael Roberts
By Michael Roberts
By Amber Taufen
By Patricia Calhoun
By William Breathes
By Michael Roberts
By Melanie Asmar
Gonzalez paid assisted-living facilities kickbacks to bus in residents suffering from retardation and dementia. The clinics would then bill Medicare for services the "patients" weren't eligible for or didn't receive.
By the time the feds started sniffing around, in 2008, Gonzalez had already made off with $28 million, enough to fund a personal fleet of 17 luxury vehicles.
He closed shop in Miami, then held a grand reopening in North Carolina. When he was finally arrested last year, Gonzalez was planning to expand into Tennessee.
Then there's Armen Kazarian, kingpin of Los Angeles's Armenian mob. The feds say his gang stole the identities of doctors and patients while setting up fake clinics across the country. They knew nothing of medicine, sending Medicare fake bills that showed eye doctors doing bladder tests, obstetricians testing for skin allergies, and dermatologists billing for heart exams.
Medicare paid out $163 million before Kazarian and 73 henchmen were caught by the FBI. His sentence would prove how little risk there was to such grand aspirations: In February, Kazarian received just three years.
Not all schemes are that flamboyant. Some simply employ sleights of paperwork. A Detroit podiatrist billed Medicare $700,000 for performing toenail removals that amounted to little more than toenail clipping. Two Miami doctors billed back rubs as physical therapy, taking in $57 million.
Some thieves are so brazen that they advertise on TV. Remember those late-night Scooter Store ads, promising to get you a motorized wheelchair "at little or no cost to you"?
In 2007, the San Antonio company agreed to pay $4 million in fines and forfeit another $43 million for advertising one scooter but delivering a more expensive model on Medicare's dime.
Executives didn't learn their lesson. The Scooter Store was soon caught again, this time for overcharging Medicare by $108 million between 2009 and 2011. But CMS agreed to a spectacularly lenient settlement, allowing the company to repay just a quarter of what it stole.
The feds would only get tough after CBS aired an investigation illustrating how the company browbeat doctors into writing unnecessary prescriptions for scooters. They raided Scooter Store headquarters in February, though they have yet to say what they were looking for.
Fraud Blossoms in the Sunshine and Heat
Warm weather attracts mold, mosquitoes and retirees with government benefits. So it's no surprise that Miami is the epicenter of health-care fraud.
It's not just the senior population conveniently warehoused in group homes and assisted-living facilities. There are also large immigrant communities that shield their own — who have quick access to countries without extradition treaties.
Then there's the culture of fraud that gallops to the very top of Florida government.
During the 1990s, Republican governor Rick Scott was CEO of the hospital company Columbia/HCA. As the feds later discovered from the largest fraud case in Medicare history, the company seemed more organized-crime outfit than health-care provider.
Columbia billed for tests that weren't necessary or ordered, submitted false diagnoses to increase reimbursements, paid kickbacks to doctors for patient referrals and billed for home visits that people didn't qualify for or receive.
The smoking gun was the two sets of books Columbia kept. One detailed all Medicare submittals. The other noted which were fraudulent, allowing Columbia to keep enough reserves to pay penalties should it ever get caught.
A whistleblower estimated that fraud alone accounted for one-third of the company's profits.
When the whip came down, in 2003, Columbia settled for $2 billion in fines for "systematically defrauding federal health-care programs." Scott claimed ignorance, though it's hard to believe that a self-described hands-on executive wouldn't know where a third of his company's profits came from.
He was eventually fired — but with the velvet landing often accorded to disgraced CEOs. Scott walked away with nearly $10 million in severance, stocks worth $300 million, and a $1 million-a-year consulting contract.
Only two lesser executives got jail time. Lead FBI agent Joe Ford would later regret allowing the company to simply pay away its sins: "People need to go to jail."
Still, fraud knows no party, race or gender. Indeed, the allegations against state representative Daphne Campbell's (D-Miami) clan could script a health-fraud installment of The Klumps.
Campbell ran ten group homes until the state canceled her Medicaid contract in 2006. Four people died in her facilities that year, including one developmentally disabled female patient who had also been raped. Inspectors found rodent feces and general squalor in the homes.
Meanwhile, Campbell's ex-con husband, Hubert Campbell, has been accused by two former partners of defrauding the state's Medicaid program.
Not to be eclipsed, their 28-year-old son, Gregory Campbell, is accused of submitting nearly $300,000 in false Medicare billings while operating adult group homes.
But the feds never really grasped the scope of all this stealing until 2007, when it landed on the novel idea of scrutinizing its bills rather than just paying them.
At the time, the Justice Department was mostly tackling medical-equipment scams involving wheelchairs, hospital beds, respiratory devices and the like.
This was an easy scam. Providers don't need a license, and lax oversight allows them to pop up overnight, bill Medicare for hundreds of thousands of dollars, then disappear just as quickly — only to reemerge elsewhere under a new name.
It's nearly destroyed 'Pain Management' in Colorado . The absolute WORST culprit in this entire health care melt down was of course Dr. Clemmons, and the damage he has done is NEARLY irreversible !
I'm an amputee who has survived being run over by a train as well as hit by a car twice . I keep ALL my records/tests up to date, but CAN'T find a Doc who specializes in pain, & trusts ANYONE ! I was NEVER one of Clemmons' patients & did NOT play games w/ my pills EVER ! Nor was I EVER accused or investigated !
I'm SO close to quitting what little I do get now & returning to on going binge drinking . This coming after quitting drinking YEARS ago !
I AM BEING FORCED TO SELF MEDICATE W/ ALCOHOL !!!