New law helps feds charge 94 peo­ple in Medi­care scams cost­ing $251 mil­lion

Austin American-Statesman - - WORLD & NATION - By Kelli Kennedy and Tom Hays

MI­AMI — El­derly Rus­sian im­mi­grants lined up to take kick­backs at 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 ar­rests this week in Mi­ami, New York, Detroit, Hous­ton and Ba­ton Rouge, La., were the largest Medi­care fraud take­down in his­tory — a re­sult of a mas­sive over­haul in the way fed­eral of­fi­cials are pre­vent­ing and pros­e­cut­ing the crimes.

Ninety-four 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 each year.

For the first time, fed­eral of­fi­cials have the power to over­haul the sys­tem un­der the Af­ford­able Care Act, which gives them author­ity to stop pay­ing a As­sis­tant At­tor­ney Gen­eral Lanny Breuer dis­cusses the Medi­care fraud cases Fri­day and shows a poster from a Brook­lyn clinic that says, ‘Don’t Gos­sip.’ provider they sus­pect is fraud­u­lent. Crit­ics have com­plained that the pre­vi­ous 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 ap- pear­ing 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 var­i­ous scams.

Sus­pects across the coun­try were ac­cused of billing Medi­care for un­nec­es­sary equip­ment, phys­i­cal ther­apy and other treat­ments that pa­tients never re­ceived. In one $72 mil­lion scam at Bay Med­i­cal in Brook­lyn, 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 and got bonuses for re­cruit­ing pa­tients. Wire­taps cap­tured hun­dreds of kick­back pay­ments doled out in a back­room by a man who did noth­ing but pay pa­tients all day, au­thor­i­ties said.

The so-called “kick­back” room had a Soviet-era pro­pa­ganda poster on the wall, show­ing a woman with a fin­ger to her lips and two warn­ings in Rus­sian: “Don’t Gos­sip” and “Be on the look­out: In these days, the walls talk.”

With the sur­veil­lance, the walls “had ears and they had eyes,” U.S. At­tor­ney Loretta Lynch said in Brook­lyn.

In a sep­a­rate Brook­lyn case, au­thor­i­ties charged six pa­tients who shopped their Medi­care num­bers to var­i­ous clin­ics. More than 3,744 claims were sub­mit­ted on be­half of one woman alone, 82-year-old Valentina Mushin­skaya, in the past six years.

At a brief ap­pear­ance in fed­eral court Fri­day, Mushin­skaya was re­leased on $30,000 bond and or­dered not to re­turn to the Sol­stice Well­ness Cen­ter, scene of an al­leged $2.8 mil­lion scam.

Au­thor­i­ties called Mushin­skaya one of the clinic’s “se­rial ben­e­fi­cia­ries,” with phony bills to­tal­ing $141,161 paid by Medi­care.

Robert Me­cea

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