Medicare scams infect Detroit as recruiters use poor to steal millions
A security guard walks through the Conner Capuchin Soup Kitchen in Detroit on Thursday. Security has helped keep away the Medicare scam artists who prey on soup kitchen clients. Poor people on the streets and in homeless shelters also are targeted. / ANDRE J. JACKSON/Detroit Free Press
- FILED UNDER
- Local News
- City Of Detroit
Fraud conference set
U.S. Attorney General Eric Holder and U.S. Health and Human Services Secretary Kathleen Sebelius will be keynote speakers Tuesday at a conference at Wayne State University on Medicare fraud.
The event will include law enforcement officials, consumer experts, providers and government agencies. The conference is the fifth nationwide to educate the public and others about the problem. Attendance at the conference is by invitation only.
It will be from 9 a.m.-12:30 p.m. Come back to freep.com Tuesday for coverage.
Nine targets
Since 2007, a joint federal task force has cracked down on Medicare fraud in nine U.S. cities.
Besides Detroit, the strike forces operate in Miami; Los Angeles; Baton Rouge, La.; New York (Brooklyn); Houston; Tampa; Chicago, and Dallas.
Dearborn Clinic operators wanted: Clara Guilarte, left, and her sister Caridad Guilarte are wanted on Medicare fraud charges.
How Medicare scam works
The Medicare scams operating in metro Detroit follow a similar pattern. Here’s how the scam worked in one recent Detroit case:
THE CLINIC
Operators pooled money to start a bogus clinic.
THE DOCTORS
The operators put ads in newspapers for medical doctors to run the clinic or used colleagues involved in scams in other states, even if they were not licensed in Michigan.
THE RECRUITERS
Clinic operators hired Medicare recruiters to find Medicare recipients in Detroit, using vans to pick up people at soup kitchens, homeless shelters and on streets in poor neighborhoods and shuttle them to surburban clinics.
PAYOFF
Medicare recipients gave the clinic their information in exchange for money, typically $50 per visit or as much as $150 for return appointments.
SCAM MONEY
Clinics used the information to fraudulently bill Medicare for millions of dollars.
THE CLINIC
Operators pooled money to start a bogus clinic.
THE DOCTORS
The operators put ads in newspapers for medical doctors to run the clinic or used colleagues involved in scams in other states, even if they were not licensed in Michigan.
THE RECRUITERS
Clinic operators hired Medicare recruiters to find Medicare recipients in Detroit, using vans to pick up people at soup kitchens, homeless shelters and on streets in poor neighborhoods and shuttle them to surburban clinics.
PAYOFF
Medicare recipients gave the clinic their information in exchange for money, typically $50 per visit or as much as $150 for return appointments.
SCAM MONEY
Clinics used the information to fraudulently bill Medicare for millions of dollars.
The corner of Third and Martin Luther King Jr. in Detroit is known as an area where Medicare scam artists prey on homeless people. / Photos by ANDRE J. JACKSON/Detroit Free Press
Brother Ed Conlin talks to clients at the Conner Capuchin Soup Kitchen in Detroit on Thursday. Conlin says he has confronted scam artists trying to get Medicare information.
How to report fraud
Medicare fraud: 800-447-8477 or e-mail: HHSTips@oig.hhs.gov
Medicaid fraud: 866-428-0005
Detroit has become one of the nation's "new frontiers" for Medicare fraud with many scams run by operators fleeing a federal crackdown in Miami.
Authorities say operators use recruiters to target poor men on Detroit streets, at soup kitchens and in homeless shelters. They shuttle them in vans to clinics set up for the scams or run by licensed providers trying to bilk the system for bogus treatments or for care never rendered or needed. Operators take their Medicare information in exchange for $50 or more.
Detroit's unemployment rate makes it a particularly vulnerable target. Authorities have identified at least $120 million in fraudulent billings in metro Detroit.
The businesses investigated include physical therapy clinics, home health care agencies, medical equipment providers and podiatry offices. More regulation and prosecution is needed, some attorneys say.
"It's like banks without an alarm system," said David Haron, a Troy attorney who specializes in Medicare and Medicaid fraud, referring to the ease with which some medical businesses are established.
Since a federal strike force was created in Detroit in 2009, there have been more than 200 arrests, resulting in 60 guilty pleas and eight convictions at trial. Two operators of a Dearborn clinic -- sisters Clara and Caridad Guilarte -- are on a federal most-wanted list after their Dearborn infusion clinic was shut down for fraud.
Yet the recruiters keep coming.
Poor people's Medicare information is being used to bilk the government
A man in white painter's pants and a black parka with a fur-lined hood chatted last week with the poor, mostly homeless men at the Conner Capuchin Soup Kitchen on the east side of Detroit.
It wasn't his first time.
"They are here every day," Marilyn Reyes, assistant manager of the kitchen, said, pointing to the man, one of many Medicare recruiters preying on poor, elderly and frail people in Detroit.
When ordered to leave, the man takes his business to the public sidewalk or to a nearby fast-food restaurant or liquor store, the staff said.
Reyes said one recruiter even threatened her a few months ago when she told him to leave, saying, " 'I'll have you killed.' ''
By the vanloads, these recruiters truck their targets to clinics, doctors' offices or other health care businesses in the suburbs, where their Medicare information is traded for $50 or more. The information is then used to bilk the federal government out of thousands of dollars in fraudulent Medicare billings.
When time doesn't allow for a trip, recruiters take pictures of their targets' red-white-and-blue Medicare cards for use in the scams.
To avoid detection during their recruiting trips, some drivers cover their license plates. Men most often are the targets, as they far outnumber women on the streets and at programs serving homeless people.
These activities continue all over the city, including at both Capuchin Soup Kitchens on the east side. The kitchens serve 1,000 meals a day, mostly to homeless men ranging from recently released prisoners to elderly Medicare beneficiaries.
The Conner Capuchin Soup Kitchen was forced to add a security guard in late February to watch its parking lot, in addition to guards who oversee the kitchen and staff inside. A recruiter mistakenly hit on guard Frank Shannon, a retired Detroit police officer, on his first day on the job, asking for his Medicare information in exchange for $50. He said he gave a bogus number to the man, who left. When he returned another day, he told the man he was a security guard hired to get rid of people like him, saying, "There's a new sheriff in town."
The Meldrum Capuchin Soup Kitchen also employs security guards inside and out, to no avail.
"They were here again today," a guard told Brother Jerry Smith, Capuchin Soup Kitchen executive director, on Thursday.
The aggressiveness and pervasiveness of these soup kitchen recruiters shows the scope of the Medicare fraud problem, despite the nation's biggest effort to end it.
Since March 2007, when the first joint federal task force began investigating Medicare fraud in Miami, 990 people have been charged with filing $2.3 billion in false Medicare billings in nine U.S. cities, including Detroit, where the task force efforts have been expanded. Investigators have identified at least $120 million in fraudulent billings in metro Detroit alone.
Federal officials estimate 3% to 10% of the $3.3 trillion the U.S. will spend on health care in 2012 will be wasted because of fraud and abuse. Cutting fraud and waste is critical to making Medicare solvent for future generations and finding money to offset costs for health reforms.
"In Detroit, and in the eight cities across the nation, our strike forces have been making a real impact," Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, said in a statement to the Free Press. "We're no longer waiting for criminals to trip up. We're working together ... to identify the bad actors early, tracking the large criminal enterprises and shutting them down.''
As the Miami crackdown intensified, health care providers moved from there to other cities including Detroit, where large populations of poor, elderly and sick people, often with AIDS and other chronic problems, "make a target-rich environment," said Tom Spokaeski, assistant special agent in charge of Detroit's Office of Inspector General, part of the Department of Health and Human Services.
Businesses Spokaeski and others have investigated include home health care clinics, podiatry offices, physical therapy businesses and doctors' offices. Some ordered costly tests and expensive prescription drugs or billed for services never rendered, according to federal court records in Detroit.
Others billed for months of physical therapy or home care for people who didn't need any care or needed much less rehabilitation.
With its high unemployment rate, Detroit is a particularly easy target.
On a tour of the Cass Corridor last week, Spokaeski pointed to an area that federal investigators call "the Beach" near Third and Martin Luther King Drive, where dozens of people mill around some days talking to Medicare recruiters waiting for them on vacant lots, outside an aging hotel and near a homeless shelter.
Spokaeski and others have helped arrest more than 120 people in Medicare fraud scams since May 2009, when the joint task force expanded to Detroit. As of last month, 60 of 120 defendants arrested in Detroit have pleaded guilty and another eight have been convicted at trial, according to the Justice Department.
The average prison sentence in Detroit is 41.4 months, with nine people getting stiffer sentences of as much as 10 years.
"Despite our efforts, there is no shortage of cases," said Barbara McQuade, U.S. Attorney for the Eastern District in Detroit.
"We want providers to know we are scrutinizing billing records, and people will be brought to justice. We are seeing very strong sentences in these cases. People who just think a slap on the wrist are mistaken. The judges in our court have taken a very harsh view to this kind of activity.''
Federal investigators also have arrested and sentenced some of the recruiters but "the problem is rampant" and issues of attempted assault or trespass typically fall to local police, Spokaeski said. The Detroit Police Department did not return calls for comment.
$2.3 million in Medicare billings in four months
Xpress opened in November 2006 in Livonia. It was set up as a drug infusion clinic to administer high-dose prescription drugs by infusion for complications resulting from AIDS and HIV, hepatitis C and other problems.
Xpress lived up to its name.
Bankrolled by several Miami health care providers who later were charged or sentenced in various scams, it billed Medicare $2.3 million before federal agencies shut it down four months later, according to federal court records.
One of the principal owners of the clinic was Juan De Oleo, 51, of Miami, who was licensed as a physician's assistant in Florida, federal court records show.
De Oleo and his partners had run other infusion clinics in Miami before coming to metro Detroit, federal authorities say.
They set up four infusion clinics -- one in Livonia, two in Dearborn and one in Southfield -- between 2006 and 2007, court records show. One of the Dearborn infusion clinics was run by Clara and Caridad Guilarte, who fled the country when their clinic was shut down for fraud. The two are now on a most-wanted list issued by the inspector general's office in the Department of Health and Human Services.
The government focused its case on the Livonia operations, where it obtained the best records to establish fraud.
To help with the scheme, De Oleo needed a doctor willing to write prescriptions and bill Medicare for costly drugs. Through a newspaper ad, he found one. But the doctor usually appeared so stoned or drunk that De Oleo then convinced his wife, Dr. Rosa Genao, a 52-year-old Miami pediatrician, to help. Genao had been involved in questionable clinic billings in Miami, according to federal court records.
Flying in to Detroit on weekends in the dead of winter, Genao directed the falsification of records to bill Medicare for costly drugs at the Livonia clinic, court records show.
The clinics rendered little care and did not even have an adequate supply of medicines for the amount of drugs they allegedly prescribed, the court records show. In all, the four clinics submitted $11 million in billings to Medicare for about six months of operations, records show.
Three homeless people caught up in the Livonia scheme are among 19 Medicare recipients in Detroit charged in the scams, typically with conspiracy to receive health care kickbacks, a felony. Most have gotten probation, according to the Justice Department.
One was Rodney Woods, who received two years of probation for giving his Medicare information to Xpress.
"Rodney Woods was a truly sick individual'' with AIDS, hepatitis C and other medical problems, said his Detroit attorney, S. Allen Early.
Early said the clinic billed Medicare $82,000 for Woods' care, but the government said Woods got mostly sham treatments or, at most, B12 vitamin shots before a van shuttled him back to Detroit.
"He was more a victim than a participant in the scheme," said Early.
Attorneys at the sentencing for De Oleo and Genao portrayed De Oleo as a silent investor in the clinics and his wife as a reluctant participant.
Letters from their pastor, family and colleagues to federal judge Denise Page Hood said the couple served as marriage counselors at their Mennonite church in Miami and Genao was a volunteer for a program in Miami called Virtuous Women that helped women raise their children.
"I can see you were kind of the rising star of your family," Hood said to Genao, referring to Genao's life growing up in Puerto Rico, attending medical school in the Dominican Republic and struggling to get licensed as a doctor in Florida.
Hood didn't buy the couple's pitch, saying both were more like top-of-the-food-chain perpetrators, compared with "the little guys" her court also has sentenced for Medicare fraud.
She sentenced De Oleo to 10 years in prison and Genao to eight and ordered the couple to pay $1.8 million in restitution.
Attorneys for De Oleo have requested a new trial. Both the husband and wife declined to comment.
De Oleo was taken away in handcuffs after his sentencing, kissing his wife on the cheek as he left the court with two U.S. marshals.
Genao awaits a letter from the federal Bureau of Prisons telling her where to surrender to serve her sentence. She threw herself on the ground under the attorney's table in Hood's courtroom after the verdict, sobbing.
New federal rules and fraud office in Michigan
New federal rules going into effect this month are an attempt to increase scrutiny of providers seeking Medicare numbers that allow them to bill the program, and to conduct unannounced inspections.
Michigan also has a newly created Office of Inspector General within its Medicaid division and has increased prosecution of health care providers who falsely bill the state-administered Medicaid program. But some providers, particularly those who bill private insurers, often can be involved in questionable activities that escape detection if the business is not required to be licensed. Such is the case with home health care agencies, imaging centers and outpatient clinics, for example. A bill to require licensing of home health care agencies awaits a hearing by the state Senate Health Policy Committee.
Still, attorneys complain that more scrutiny is needed, particularly before a business is allowed to open, and more resources are needed to prosecute illegal and questionable activities.
"There needs to be more resources to vet the people" before they open any type of health care business in Michigan, said David Haron, a Troy Medicare and Medicaid fraud attorney.
No comments:
Post a Comment