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Medicare fraud bust: $251M in scams
94 people netted
MIAMI (AP) — Elderly Russian immigrants lined up to take kickbacks from the backroom of 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 busts carried out this week in Miami, New York City, Detroit, Houston and Baton Rouge, La., were the largest Medicare fraud takedown in history — part of a massive overhaul in the way federal officials are preventing and prosecuting the crimes.
In all, 94 people — including several doctors and nurses — were charged Friday in scams totaling $251 million. Federal authorities, while touting the operation, cautioned the cases represent only a fraction of the estimated $60 billion to $90 billion in Medicare fraud absorbed by taxpayers each year.
For the first time federal officials have the power to overhaul the system under Obama’s Affordable Care Act, which gives them authority to stop paying a provider they suspect is fraudulent. Critics have complained the current 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 told The Associated Press after speaking 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 new 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 at a news conference 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, over 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.
Her nephew, Vladimir Olshansky, told reporters his Ukrainian-born aunt suffers from diabetes. “She doesn’t know what this is about,” he said. “She’s in the dark.”
In Miami, Daniel R. Levinson, inspector general of HHS, which oversees Medicare, said the arrests “illustrate how health care fraud schemes can replicate virally and migrate rapidly across communities.”
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