26 Arrests In Medicare Fraud Case

Associated Press

FORT LAUDERDALE, Fla. — Federal agents arrested 26 suspects in three states Tuesday, including a doctor and nurses, in a major crackdown on Medicare fraud totaling $61 million in separate scams.

Arrests in Miami, Brooklyn and Detroit included a Florida doctor accused of running a $40 million home health care scheme that falsely listed patients as blind diabetics so that he could bill for twice-daily nurse visits.

The U.S. Department of Justice and U.S. Department of Health and Human Services said the indicted suspects lined up bogus patients and otherwise billed Medicare for unnecessary medical equipment, physical therapy and HIV infusions.

Indictments were issued for 32 people in all, but the status of the other suspects wasn't immediately known.

Miami Dr. Fred Dweck, along with 14 people with whom he worked, was accused in an indictment of running a scam to tap a Medicare program that pays very high rates to care for the sickest patients.

Dweck referred about 1,279 Medicare beneficiaries for expensive and unnecessary home health and therapy services, bribing the owners of two Miami clinics to join the scam. He also faked medical certifications, according to the indictment.

A telephone listing for Dweck could not be found and it was unclear if he had a lawyer.

"No matter what type of fraud is committed, there is one common denominator and that denominator is greed," Assistant Attorney General Lanny Breuer said. "Medicare fraud is not a victimless crime. It hurts every American taxpayer by raising the cost of health care."

The raids come a week after a report that Miami-Dade County received more than half a billion dollars from Medicare in home health care payments intended for the sickest patients in 2008, which is more than the rest of the country combined, according to a report by the Department of Health and Human Services' Office of Inspector General. Medicare paid the county about $520 million, even though only 2 percent of those patients receiving home health care live here.

In Detroit's raids, suspects paid recruiters to find patients willing to feign symptoms to justify expensive testing, including nerve conduction studies, federal authorities said.

A mother and son were charged in Brooklyn with billing Medicare $246 per patient for expensive shoe inserts reserved for diabetes patients, even though they only provided cheap, over-the-counter versions.

Including Tuesday's arrests, a Medicare Fraud strike force formed by the Justice and Health departments has now charged suspects accused of bilking Medicare of more than $1 billion in less than two years.

The pilot strike force, which started in Miami in 2007, has indicted more than 460 suspects in Medicare fraud scams. The program is now in Los Angeles, Houston and Detroit. HHS Secretary Kathleen Sebelius also announced Tuesday the operation will expand to Tampa, Fla., Baton Rouge, La., and Brooklyn.

Cleaning up an estimated $60 billion a year in Medicare fraud will be key to President Barack Obama's proposed health care overhaul. HHS and DOJ have promised more money and manpower to fight the fraud.

More Info on Medicare Programs

This time from Florida.

Time To Change Medicare Programs

By ADON TAFT, Life to the Fullest

Hernando Today

Published: December 1, 2008

This is the annual open window period for either signing up for various Medicare programs or to switch from one to another. If you are confused about which plan you should choose, you can get advice from an impartial person trained to help you decide before Jan. 1 which plan is best for you.
The aid is provided by 400 volunteer counselors throughout the state serving with the SHINE (Serving Health Insurance Needs of Elders) program. You can get assistance by calling, toll free, the Elder Helpline at 1-800-963-5337. They will give you the time and place counseling sessions are available. If you are unable to get to any of those places at those times, your phone number will be taken and a counselor will call you to discuss Medicare eligibility, enrollment and coverage issues; health plan choices; appeal rights; Medigap (Medicare supplemental) policies; Medicare prescription drug (part D) plans; long-term care options; prescription assistance resources; or Medicaid details.
A good way to do your own research and comparison of policies is to get on the Internet and look on the official site at www.medicare.gov. Good explanations of the differences between types of policies and comparisons of their features are to be found there.
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More than 1.7 million Floridians (that's one of 10 residents) are caring for a frail elder, reports the state's branch of the AARP. That organization's survey found that 77 percent of adults 35 or older would prefer to receive long-term care at home rather than in a nursing home.
So Lori Parham, state director of the AARP, is bucking to change Florida's status as 41st in the nation in achieving a balance between community-based and nursing home care, where Florida spends 91 percent of Medicaid's long-term care funds.
The average cost of a nursing home stay is about $75,000 a year while care at home costs about $20 an hour.
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One Florida business ranked in this year's AARP top 10 list for best employers for 50-year-old or older workers. It is Lee Memorial Health System based in Fort Myers where 38 percent of the 9,204 employees are 50 or older.
Those enrolled in the company's health plan receive free generic medications for treating cardiovascular disease, diabetes and high cholesterol. They also have access to free clinics at all of the system's hospitals and, at a minimum cost, personal trainers, dietitians and nurses' supervision in a weight-loss program.
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Thanks to the Mortgage Forgiveness Debt Relief Act, you now have up to two years following your spouse's death to sell your jointly owned house and keep up to $500,000 in profits tax free.
Previously, a widowed homeowner had to sell the house the same year as the spouse's death to qualify for the tax break.
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In today's economy, 10 percent of Americans 65 years of age or older have turned for help from families or charities, according to a story by Peter Jaret in a recent edition of the AARP Bulletin. But of those eligible for food stamps, only 34.5 percent of them apply for that aid.
The same issue reported that 1.3 million Medicare beneficiaries are having trouble finding a primary care physician because of a shortage of doctors going into general practice.
Since Medicare and insurance companies establish the fees, primary care doctors are forced to take on more patients and work longer hours to generate revenue. Therefore they spend less time — as little as 15 minutes — with each one, the article quotes a spokesman for the American College of Physicians.
In addition, general practice doctors earn half or less than what many specialists earn. Consequently, only 13 percent of first-year residents in internal medicine in a recent survey indicated an intention to enter a general practice.
Adon Taft is a resident of Brooksville. If you have questions about any issue connected with aging, except medical conditions, please write to Life to the Fullest at Hernando Today, 15299 Cortez Blvd., Brooksville, Fla. 34613, or send e-mail to adontaft@yahoo.com. Please include your name and address.