Fla. Medicare fraud debate focuses on patients

[AlphaCentauri]

Source: AP

Three days a week Philip Audette sat in a cushy white chair at the St. Jude Rehab Center, a needle pumping HIV drugs into his arm. He talked and laughed with a dozen other patients, all in good health, all receiving drugs they didn't need. All for the money.

Audette says he made $100 to $200 every visit, nearly $10,000 over several months, selling his Medicare number to the clinic's three owners, the Benitez brothers, who were later indicted on charges of bilking $119 million from Medicare.

Authorities say there are thousands in South Florida like Audette, and federal officials say they play a large role in the fraud overwhelming the national Medicare system. While authorities are successfully cracking down on clinic owners, they disagree over whether prosecutors should go after the patients who get the phony treatments in addition to the clinics that provide them.

"Unless patients are prosecuted, we will not have a true long-term impact," says Kirk Ogrosky, deputy chief of the U.S. Justice Department's criminal fraud section and an advocate for arresting patients, something that rarely happens in Miami and Los Angeles, the two cities where federal healthcare fraud task forces are based.



Read more: http://www.google.com/hostednews/ap/article/ALeqM5iCLs0YKM3bDnEbQOR22InN7b2FoQD959898O2

[Sarah Ibarruri]

1. Miami is corruption central, and has been Republican to the hilt

Where you find Republicans, you'll find big time corruption.

[XanaDUer]

3. I grew up in Miami, lived there for many years

The Cuban exile community, albeit a powerful voice in local politics, are Republican-Miami is hardly a hub of Republicanism.

However, I do agree about the corruption. In the 1980s, some of the Miami City Police were as dangerous as the criminals running around.

Now that I live in Georgia, I can appreciate what truly living in a Republican-to-the-hilt area is like.

EDIT: Typo.

[Sarah Ibarruri]

8. You've got to be kidding me. Cubans are the most important Florida community to the GOP nt

[FlaGranny]

16. Sure they are, but

Miami isn't 100% Cuban - yet.

[XanaDUer]

18. Correct.

A large African-American community in Liberty City and OVertown; a large Jewish community in Aventura and, to a much lesser extent now, North Miami Beach and Bal Harbor.

In the SW, Coral Gables and Coconut Grove (home of one of the first condom stores waaaay back in the 1980s) have large Anglo communities, and the Caribbean-African-American Community in the Grove, a large gay community.

I had a lot of friends of all stripes and I cannot remember one Republican. How lucky I was at the time!

[XanaDUer]

17. No, I'm not kidding you at all

Miami is a very, very diverse community. And, younger Cubans are gravitating towards the Democratic Party.

Even when Southern Baptist Crackers ran the place up until, roughly, the mid-1970s, most of them were Democrats.

I lived there until a few years ago.

[Sarah Ibarruri]

21. Hopefully, but they've been severely right wing for decades...

In fact, people in this community actually were murdered for openly admitting to not being Republican.

[XanaDUer]

24. People in the older exile Cuban community were murdered

for saying they were not Republicans? Do you have a link to that information, or another source?

Miami is corrupt, but so are a lot of other places. NYC has all sorts of Medicaid fraud cases, and that is hardly a hub of Republicanism, either.

Let me give you an example of what I'm talking about: Remember Elian Gonzalez, and how he was used by the right-wing , Jorge Mas Canosa-types of old-guard Cuban exiles, and their supporters (there were many) to show how God had sent that young man to the US for freedom, apple pie, baseball, and all the wholesome things America has to offer, and how the mean old commie dad in Cuba wanted (correctly) his son back?

I cannot tell you the joy the massive bitch-slap Clinton and Reno (another Miami Democrat) provided some of those holier-than-thou, right-wing freaks in Little Havana and Hialeah when they did the right thing and got that poor kid out of the slum he was in. It was like, "Finally, someone has the balls to say fuck you to that community of nut jobs."

I have an early memory, circa 1973-74, of my mother driving us by the Torch of Friendship down in Bayfront Park on Biscayne Blvd, having non-Exile Cubans and Anglos (slang term for non-HIspanics in South Florida) throw rocks thrown at them by the upstanding, anti-Communist Cubans. My mother, a born-and-bred NYC liberal, just shook her head in disgust at them. We kept driving.

Sure, Miami has the so-called freedom fighters, still, because it makes them important in certain portions of their community. But:

http://www.miamicubandems.org/


1. There is a revolution in public opinion and in the mass media today in Miami. The monopoly over radio and opinion held by the traditional views of US- Cuban Relations are giving away. Progressive exile leaders, together with Mariel exodus generation leaders, recently arrived Cuban immigrants and the US born generations are increasing their role in the public arena. Thus we encourage diversity of opinion and a greater respect for freedom of expression in Miami.

2. Recent Corruption scandals in Miami Dade have been a national embarrassment. Greater resources should be provided to law enforcement agencies investigating public corruption as well as Florida state attorneys responsible for prosecuting those charged with violating the public trust. The Florida Department of Law Enforcement and the Federal Bureau of Investigations should also be invited to conduct independent investigations in the county when conflicts of interest arise. The Democratic Party must also be responsible for nominating candidates beyond reproach. The party needs to make public ethics education mandatory for nominated candidates.

However-there are still tons of liberals there-Miami is a weird place, and I miss it everyday.

Any fellow South Floridians here? Or ex-pat ones?:

Who could forget Anita Bryant's Miami legacy? Old "Paper Roses" Anita Bryant did not like a 1977 anti-gay-discrimination ordinance that passed:

http://www.alternet.org/story/17737/

Or Miami housewife, Marabel Morgan?:

Andelin is not the only woman preaching a potent antifeminist message rooted in conservative Christian teachings. Her most popular rival is Marabel Morgan, 37, of Miami, a housewife and mother of two. Morgan's book, The Total Woman, released quietly in late 1973 by Fleming H. Revell, an obscure New Jersey publisher, sold 370,000 copies at $5.95 to become the nation's top non-fiction bestseller in 1974. (It was missing from most bestseller lists because it was sold mainly in small-town shops and bookstores unpolled by the list makers.)

[Sarah Ibarruri]

26. Sure some things have changed, but the reality is there still are terrorist groups in Miami

Sure, a lot of the Batista dictator lovers are dead or old, but things die very slowly.

It's an interesting topic for people to do searches on who don't realize how much oppression there has been in Miami, Florida. Cubans who had enjoy great wealth under the bloody dictatorship of Batista set up a nice network of terrorism, with the ever-present help of Republicans and the CIA:

Omega 7
Alpha 66
CIA and Miami Cubans
Orlando Bosch
Luis Posada Carilles
CANF
FLNC
Secret Revolutionary United Cells
Condor
Cuban C-4

(And about 100-200 more which I haven't bothered with).

[XanaDUer]

27. Yeah, I remember those nuts going out to the Everglades to practice

war games to retake Cuba once Castro died. What a bunch of assholes. Many of these groups had the Feds looking the other way since they were the "right" (and I do mean right as in right-wing) types of terrorists.
Then there were "Brothers to the Rescue" that was always causing trouble, too.

Ah, Miami. I need to start checking to see if any jobs in my field are open again.

I do miss it!

:)

[Warpy]

5. Yes, especially when they can bilk social services

in order to discredit the concept.

Republicans are scum. So is everybody who took part in the scam.

All of them need to be prosecuted, fake patients and scammers alike.

[Sarah Ibarruri]

9. Republicans are definitely scum. I'm totally with you on that.

Also, Republicans have been corrupting Miami Cubans for the longest time.

Case in point: They offer lunches to very poor Cuban old people. There are buses that take them to lunchrooms. Weeeell, at the lunchrooms they tell them to vote Republican. They register the old people as Republicans, and on election day drive them to the polls after having explained to them to vote only Republican. How do they do this? With speeches at the lunchrooms. They tell the old people that they will lose their free lunches if Democrats are elected, and this scares the old people who are already poor and old, and terrified of losing their free lunch.

[cstanleytech]

12. Umm people, I love bashing republicans as much as the next person here,

(in fact its a major hobby of mine on another forum :evilgrin: ) but the real question I feel about the article is should they be going after the patients assisting in the bilking as well?
Offhand I'm leaning towards a yes they should, how about you?

[jbnow]

19. Patients might not know they are getting treatment they don't need

Way too few patients ask a lot of questions. If a doctor said "You've got a problem with your blood (or heart or a precancerous condition or whatever) and need to come in X times per week" many would take it on faith. Even taking money wouldn't prove wrong doing since they could be told it's given to cover expenses or that it's part of a study.

Patients who are knowingly part of fraud should be charged but their part really needs to be proven. The patient doctor relationship has all the power on the doctor's side, it's unequal. The "job" of a patient is to comply

[cstanleytech]

20. Well I did say "patients assisting", as in they know its scam and the government has

evidence to back it up in a court of law.

[Sarah Ibarruri]

22. Yes nt

[Judi Lynn]

2. This racket has been going on in South Florida for AGES, with Jeb Bush's Cuban associate,

Miguel Recarey, having pulled off the largest Medicare fraud in US history at the time of the discovery of his scam, which was apparently protected by _{Jeb Bush.} Once the spotlight fell on Recarey, he fled the country, going to Venezuela and also to Spain to hide from U.S. justice.

To get a sense of the size of his crime, see this Mother Jones article:

Bush Family Value$
News: The Bush clan's family business
By Stephen Pizzo
September 1, 1992

~snip~
Recarey also surrounded himself with those who could influence the political system. He hired Jeb Bush as IMC's "real-estate consultant." Though Jeb would never close a single real-estate deal, his contract called for him to earn up to $250,000 (he actually received $75,000). Jeb's real value to Recarey was not in real estate but in his help in facilitating the largest HMO Medicare fraud in U.S. history.

Jeb phoned top Health and Human Services officials in Washington in 1985 to lobby for a special exemption from HHS rules for IMC. This highly unusual waiver was critical to Recarey's scam. Without it, the company would have been limited to a Medicare patient load of 50 percent. The balance of IMC's patients would have had to be private -- that is, paying -- customers. Recarey preferred the steady flow of federal Medicare money to the thought of actually running a real HMO. Former HHS chief of staff McClain Haddow (who later became a paid consultant to IMC) testified in 1987 Jeb that directly phoned then-HHS secretary Margaret Heckler and that it was that call that swung the decision to approve IMCs waiver.

Jeb admits lobbying HHS for the waiver, but denies talking to Secretary Heckler -- and denies as well the charge that his call won the HHS exemption. "I just asked that IMC get a fair hearing," said later. After the IMC scandal broke in 1987, Heckler left the country, having been appointed U.S. ambassador to Ireland, a post she held until 1989. (Heckler is now a private citizen living in Virginia. We left a detailed message with her secretary, outlining our questions, but she declined to respond.)

In any case, the highly unusual waiver by federal officials allowed IMCs Medicare patient load to swell -- to 80 percent -- and the money poured in. At its height in 1986, IMC was collecting over $30 million a month in Medicare payments; in all, the company would collect $1 billion from Medicare. (Jeb would not discuss the IMC affair with Mother Jones. But in an opinion piece he wrote for the Miami Herald last May, he insisted that he had worked hard for IMC, looking for real-estate deals, and had earned his $75,000 in commissions. While acknowledging making a telephone call to one of Heckler's assistants on IMC Is behalf, he claimed the waiver was not granted on his account. The allegation of a connection, Jeb wrote, "is unfair and untrue.")

Despite Jeb's involvement, trouble began brewing for IMC when a low-level HHS special agent in Miami, Leon Weinstein, discovered that Recarey was defrauding Medicare through overcharges, false invoicing, and outright embezzlement. Weinstein had been following Recarey's activities since 1977, and as early as 1983 he believed he had enough information to put together a case. However, he found his HHS superiors less than receptive; they took no action on Weinstein's information.

But Weinstein kept digging and in 1986 renewed his investigation of Recarey and IMC -- and again his HHS superiors blocked the probe. "Washington just refused to pursue my evidence," Weinstein, now retired, told Mother Jones last spring. "And they made it perfectly clear that I was not to pursue IMC. When I did, they threatened me and threatened my job."

More:
http://www.motherjones.com/news/feature/1992/09/bushboys.html?welcome=true

The latest scam has made very wealthy people of some Cuban "exile" criminals who have taken vastly more from US taxpayers than anything would ever reveal concerning their street people pawns, esssential to them to be able to bilk us all. From the new article, posted by AlphaCentauri:

The patients, mostly Cuban-Americans, are recruited by brokers who go door-to-door, offering hundreds of dollars for use of their Medicare numbers, a tactic The Miami Herald first reported. They often target new citizens and immigrants, sometimes entire families. Many barely speak English.

At some apartment buildings, brokers compete for patients, promising to pay them more in kickbacks than another company is giving them, Ogrosky said.

Former professional patient Audette says a friend asked him if he wanted to make some quick money and introduced him to a broker named Oscar about five years ago. After Oscar took Audette and his partner to get blood tests confirming they were HIV positive, they met him three days a week in downtown Fort Lauderdale and were bused with about 18 other patients to the Miami clinic.

The Benitez brothers, who owned St. Jude and 10 other clinics, bought hotels, helicopters, boats, even a waterpark with their spoils and allegedly fled to Cuba, where authorities believe they remain. A doctor found guilty in the scam was sentenced to 30 years in prison last week, one of the stiffest penalties ever imposed for Medicare fraud. A physician's assistant received 14 years.

Top left: Carlos Benitez, top right: Jose M. Benitez,
bottom left: Luiz E. Benitez, bottom right: Bavaro Water Park.
Photos U.S. Marshalls Service.From last August:

Local - 5 August 2008, 7:37 AM Text size: Smaller Bigger
Benitezes flee, leave behind US$ millions in Dominican properties

SANTO DOMINGO.- The Justice Ministry believes the Benítez brothers, implicated in a US$110 million fraud against the U.S. Medicare service, managed to flee from the Dominican Republic, leaving behind as much as one billion pesos in properties mostly in the country's east coast.

"The information we have, from the migratory flow as well as from the interviews of the Benítezes’ workers, is that they have possibly left the country," said German Miranda, head of the Anti-laundering Unit, quoted by newspaper Diario Libre. He said the whereabouts of Carlos, Jose and Luis Benítez unknown.

The Cuban-born suspects bought villas, apartments, hotels, boats, a helicopter, even a water park in the resort Bavaro (east) area, and as many as 38 lots in the nearby city Higuey, Miranda said.

The official also revealed that evidence gathered so far implicates 60 people, suspected of being associates of the Benítezes, "because they are involved with the Benítez brothers or have done business with them and they’ll have to clarify their investment in that regard."

Meanwhile, the Miami Herald reports that after Carlos, Jose and Luis Benitez were indicted on fraud charges for billing $110 million in false claims in late May, they used their Cuban passports to travel from Miami to the Dominican Republic, then to Cuba. It said the Benitezes, who arrived in the U.S. in 1995 and became U.S. citizens five years later -- have a lot of company.

http://www.dominicantoday.com/dr/local/2008/8/5/28928/Benitezes-flee-leave-behind-US-millions-in-Dominican-properties

[Trillo]

4. The clinic provided false test results?

Is the allegation that Audette isn't in fact HIV positive, that the clinic provided false test results, and that Audette was fully aware they were bogus?

[onethatcares]

6. every freaking one of them should be prosecuted

jeeezusonabender, throw the damn book at the clinics and the clinic owners, but don't let the "patients" get off with probation or they'll end up selling more causing more fraud.

And we wonder why we can't have single payer universal health care in the United States of America.

[defendandprotect]

7. These weren't "patients" -- these were co-conspirators ....

and they should be prosecuted --

[Tansy_Gold]

10. If they were scamming a private, for-profit insurance company,

they would be prosecuted. Indeed, those who knowingly engage in insurance fraud ARE prosecuted, whether they are doctors, patients, or third party facilitators.

Though publicly funded, Medicare is still essentially an insurance company and should be as aggressive in the prosecution of fraud as any other.

As tax-payers, we're the stockholders in Medicare. We should demand prosecution and, in the event of conviction, restitution.


Tansy Gold, who provides support service to insurance companies investigating fraud

[defendandprotect]

11. And when the public thinks of Medicare fraud ....

they don't have visions of this -- organized crime.

They usually think it's individual patients ripping off the system.

Wonder how much press this has gotten?

[undergroundpanther]

14. zilch

I reported a crime to medicare,this program was ripped off one hundred thousand bucks by a scam the providers were doing.I overheard it.I reported it,to the state.They made my time going there a living hell until they found excuses to kick me out.

Medicare fraud is mostly perpetrated by "providers" who after they win the bid by the state (being the cheapest)who provide a service. After they get the contract than they fudge numbers cook books and steal bit by bit or funnel money that should be going to patient care into some offshore account.The kickbacks and fraud is astounding and it is the providers who scam the most.

[SharonAnn]

23. They should think of HCA, the Frist family enterprise and its $1.2 billion Medicare fine

HCA was started by Sen. Bill Frist's father, who was Chairman of the Board. Bill Frist's brother was President of HCA. HCA was investigated by Medicare for fraudulent billing practices and was fined more than $1.2 billion in fines.

This occurred around 2002. Too bad it didn't get much press, not even in Tennessee.

[undergroundpanther]

13. get insurace out of medicine

get privatized bidding out of medicare.

Make health care NOT FOR PROFIT universal system pays set fees for treatments.

And prosecuting patients for a PROVIDER'S scam and fraud is WRONG.The patients were NOT making any money for the tratments this guy was doing.Prosecute upper management first always, prosecute those Ceo PIGS who stole and profited of patients ignorance.The rich must be made to stop stealing and fucking up,the riich and the greedy who are in charge are the problem.And sociopaths gravitate to places where THEY can control ,scam money and get power,and be held unaccountable.
Arrest all the rich pig ceo old boy networks until it is no more..
The RICH and GREEDY ARE the PROBLEM as to why every "system is exploited.WE who witness the company wrongdoing have to speak out and tell the truth to others.Whistle blowing puts a leash on the greedy.

[Pharlo]

15. As far as I'm concerned, not only should they prosecute the 'patients',

they should deny them any state funded future medical care that arises from pumping these pharmaceutical cocktails into a healthy body. Why should the tax payer get victimized a second time for their greed and stupidity?

[riverdeep]

25. And this at a time when states are slashing public assistance left and right.

How much of the taxpayer's money actually makes it to where it's supposed to go?

Absolutely prosecute them, all of them that were involved.