Billings Used Dead Doctors’ Names

By Christopher Lee, Washington Post Staff Writer
washingtonpost.com | Wednesday, July 9, 2008

Medicare has paid as much as $92 million since 2000 to medical suppliers who billed the government for wheelchairs and other home equipment purportedly prescribed by physicians who, according to records, were dead at the time, congressional investigators said yesterday.

The Centers for Medicare and Medicaid Services (CMS) honored about 500,000 such claims despite pledging six years ago to correct the problem, which was identified by the Health and Human Services Department‘s inspector general in 2001.

In more than half the cases studied, the doctor listed as having ordered the equipment had died more than five years earlier, said a report by the Senate Homeland Security and Governmental Affairs Committee’s permanent subcommittee on investigations.

“We discovered that some medical equipment suppliers have scammed the Medicare system — and the American taxpayers — out of massive amounts of money,” Sen. Norm Coleman (Minn.), the panel’s top Republican, said in a statement. “Using the ID numbers of dead doctors, these scam artists have treated Medicare like an ATM machine, drawing money out of the government’s account with little fear of getting caught.”

The report is part of the committee’s ongoing investigations into waste, fraud and abuse in the fast-growing federal health program, which serves more than 43 million elderly and disabled Americans. Medicare pays annually more than $400 billion in benefits and is a fixture on the Government Accountability Office‘s “high-risk” list of troubled programs.

Last year, the government established a Medicare Fraud Strike Force to crack down on a problem that officials estimate costs taxpayers tens of billions of dollars annually. The program’s durable medical equipment component, in particular, has been a frequent target of companies seeking to bilk the government. The subcommittee has scheduled a hearing on the problem today. When the system works properly, a physician writes a prescription for home medical equipment for a Medicare beneficiary. He takes the order to a supplier, who sells or rents the equipment to him. The supplier, in turn, submits a claim for payment to a Medicare contractor for processing. The claim includes a number issued by Medicare that identifies the prescribing physician.

Senate investigators obtained from the American Medical Association a computer file of physicians who had died between 1992 and 2002. They selected 1,500 at random and asked Medicare officials to turn over medical-equipment claims filed with those doctors’ Medicare ID numbers between 2000 and 2007.

During that time, the review said, ID numbers for 734 deceased doctors were used to file 21,458 claims that totaled $3.4 million. Investigators counted the claims only if the equipment was bought more than a year after the doctor’s death.

Extrapolating from the sample, investigators estimate that 384,730 to 572,238 such fraudulent claims were submitted during that period, and Medicare paid an estimated $60 million to $92 million. There are still active ID numbers in Medicare’s system for as many as 2,895 dead physicians, investigators said.

They examined separate data for Florida, home to many retirees and a perennial leader in Medicare fraud. They found that more than a quarter of deceased Medicare doctors there still have active ID numbers in Medicare’s system.

The ID for one doctor, who died in 1999, appeared on 83 claims submitted by Professional Gluco Services Inc., a Miami company, between November 2005 and September 2006. A federal grand jury indicted two of the company’s owners last year on charges of defrauding the government of $1.3 million for equipment that had never been ordered or delivered. Both men pleaded guilty.

Medicare officials had promised to do a better job screening claims after the 2001 inspector general’s report found that the agency had paid $91 million for medical supply claims with invalid or inactive physician ID numbers in 1999.

Medicare officials said several new steps should help, including a plan to match monthly Social Security Administration data about U.S. deaths against a revamped Medicare provider-identification system. They also pointed to new accreditation requirements for suppliers under a new program, opposed by the industry, that sets some equipment prices through competitive bidding.

“Fraud and abuse in the context of Medicare-covered durable medical equipment has been a focal point of ours in recent years,” said CMS spokesman Jeff Nelligan. “Before this program, anyone could become a supplier, but now they must be fully accredited based on strict financial and quality standards.”

 

Texas Attorney General Abbott’s Medicaid Fraud Control Unit Uncovers $6.1 Million Scheme; 11 Indicted

Eleven Houston suspects face felony Medicaid fraud charges

Texas Attorney General News Release
June 23, 2008

Austin, Texas – Texas Attorney General Greg Abbott’s Medicaid Fraud Control Unit (MFCU) has arrested three Medicaid providers for their involvement in a $6.1 million scheme to defraud Texas taxpayers. Seven other providers also were taken into custody while one fugitive remains at large. Harris County District Attorney Ken Magidson’s office will prosecute the suspects, who face multiple felony charges for participating in organized criminal activity.

The arrests stemmed from MFCU’s investigation into a Humble-based medical billing service, Frazier Medical Marketing, and its owners Dyain Eligha Frazier, 35, and Tajuana Krischell Frazier, 35. According to MFCU investigators, the Fraziers colluded with eight durable medical equipment companies to bill the Texas Medicaid program for supplies that were never delivered to recipients.

“These defendants are charged with orchestrating a complex scheme to bill Texas taxpayers for services not rendered,” Attorney General Abbott said. “The Medicaid program is designed to help the neediest Texans, including children and seniors, with basic health care services. Unfortunately, some Medicaid providers submit false billing records, thereby illegally enriching themselves to the detriment of the taxpayers and patients who depend upon Medicaid for health care.”

Attorney General Abbott added: “Thanks to an outstanding effort by the Medicaid Fraud Control Unit, the Texas Health and Human Services Commission and the Harris County District Attorney’s Office, a multi-million dollar scam to defraud the taxpayers has been shut down. We are grateful to HHSC for bringing this case to our attention and to Harris County District Attorney Ken Magidson for prosecuting the suspects in this case.”

MFCU investigators arrested the Fraziers on June 10 at a luxury automobile dealership in Houston, where the couple was attempting to trade in a 2006 Bentley for a new Mercedes-Benz and cash. The suspects were booked into the Harris County Jail.

The MFCU also arrested Charles Robertson Wickware, 26, on May 30, on charges that he received more than $400,000 in fraudulent reimbursements. On July 12, Mississippi authorities arrested another suspect, Vincent Alan Walker, 38, who operated Dreammakers Medical Supply in Humble. Walker is accused of receiving more than $300,000 in fraudulent Medicaid reimbursements.

Six providers voluntarily surrendered to law enforcement authorities, including:

• Demetria Monique Boston, 34, who operated Anointed Medical Supply in Houston; accused of stealing more than $1.9 million

• Marcus Lee Jefferson, 34, a former contractor with Anointed Medical Supply; accused of supplying illegally obtained Medicaid recipient numbers used to bill the program

• Wilma Perkins Gibson, 42, who operated Perkins Mobility in Houston; accused of stealing more than $300,000

• Christopher Charles Williams, 37, who operated Resource Solutions Medical Supply in Houston; accused of stealing more than $400,000

• Robert Christopher Turner, 38, and Jeffrey Bernard Scales, 37, who operated First American Medical Supplies in Humble; accused of stealing more than $400,000

Jacqueline Ann Briscoe, 41, who operated Briscoe Medical Supply in Houston, is accused of receiving more than $180,000 in illegal Medicaid reimbursements. Briscoe remains a fugitive. Texans with information on her whereabouts should contact the Medicaid Fraud Control Unit at (800) 252-8011.

The cases stemmed from a November 2006 MFCU investigation into 32 Harris County businesses that illegally billed Medicaid for adult diapers, wheelchairs and other medical supplies that were never provided to recipients. Thirty-three people were indicted in a scheme that cost Texas taxpayers more than $7 million. During the 2006 investigation, MFCU personnel conducted more than 1,200 interviews and prepared numerous investigative reports, including evidence against C&M Medical Equipment, which uncovered the Fraziers’ unlawful billing scheme.

In 2006 alone, the costs of the Medicaid program in Texas totaled more than $17 billion. As the state’s chief law enforcement official, Attorney General Abbott has dramatically expanded the Medicaid Fraud Control Unit to save more taxpayer dollars and increase protection for Texas seniors. The Unit has established field offices in Corpus Christi, Dallas, El Paso, Houston, Lubbock, McAllen, San Antonio and Tyler through authorization and funding from the 77th Texas Legislature. Attorney General Abbott’s MFCU works with federal, state and local agencies to identify and prosecute those who defraud Medicaid.

Attorney General Abbott’s MFCU was honored in 2004 by the U.S. Department of Health and Human Services with the Inspector General’s State Fraud Award for effectiveness and efficiency during federal fiscal year 2003 in combating fraud, patient abuse and neglect in the Medicaid program.

To obtain more information about the Attorney General’s efforts to fight Medicaid fraud, access the agency’s Web site at www.texasattorneygeneral.gov.

 

Medical Fraud a Growing Problem

Medicare Pays Most Claims Without Review

By Carrie Johnson
Washington Post Staff Writer
Friday, June 13, 2008; A01

MIAMI — All it took to bilk the federal government out of $105 million was a laptop computer.

From her Mediterranean-style townhouse, a high school dropout named Rita Campos Ramirez orchestrated what prosecutors call the largest health-care fraud by one person. Over nearly four years, she electronically submitted more than 140,000 Medicare claims for unnecessary equipment and services. She used the proceeds to finance big-ticket purchases, including two condominiums and a Mercedes-Benz.

Health-care experts say the simplicity of Campos Ramirez’s scheme underscores the scope of the growing fraud problem and the need to devote more resources to theft prevention. Law enforcement authorities estimate that health-care fraud costs taxpayers more than $60 billion each year.

A critical aspect of the problem is that Medicare, the health program for the elderly and the disabled, automatically pays the vast majority of the bills it receives from companies that possess federally issued supplier numbers. Computer and audit systems now in place to detect problems generally focus on overbilling and unorthodox medical treatment rather than fraud, scholars say.

“You should be able to spot emerging problems quickly and address them before they do much harm,” said Malcolm Sparrow, a Harvard professor and author of “License to Steal,” a book about health-care fraud that advocates for greater federal vigilance. “It’s a miserable pattern, a cycle of neglect followed by a painful and dramatic intervention.”

Fallout from the Campos Ramirez case continues. After pleading guilty to filing false claims, she has helped authorities win indictments against more than half a dozen doctors and patients who allegedly accepted kickbacks for pretending to receive costly HIV drug therapy. With cooperation from Campos Ramirez, FBI agents this week arrested three Miami-area men who, the government alleges, financed sham clinics that billed the government more than $100 million.

Daniel R. Levinson, the inspector general of the Department of Health and Human Services, has warned repeatedly that the Medicare program is “highly vulnerable” to fraud, particularly in South Florida, where schemes center on expensive, infusion-based HIV medications and on equipment such as wheelchairs, walkers, canes and hospital beds.

Officials from the Centers for Medicare and Medicaid Services (CMS), which oversees federally funded health programs, say they have stepped up their efforts to combat fraud over the past year by working closely with investigators, removing the requisite billing numbers of nearly 900 companies and imposing new standards in high-fraud areas that would prevent people convicted of felonies from ever receiving a Medicare number.

“There’s always more fraud than we have resources to combat,” said Kimberly L. Brandt, director of program integrity at CMS. “We have done a much better job of realigning our resources to attack this problem.”

Investigators and prosecutors trained their focus on Miami after noticing two troubling patterns:

· HHS investigators discovered that nearly half of 1,581 medical equipment companies they visited in the Miami area did not comply with basic Medicare requirements to be open during scheduled hours and to have a telephone number. The inspector general and the Government Accountability Office have flagged weak oversight of these kinds of suppliers for a dozen years, according to congressional testimony.

· The South Florida region bills Medicare more than $2 billion each year for injectable HIV medications. That figure is 22 times as high as the amount of similar claims in the rest of the country, and is far out of line with demographic data in a population of 2 million people in Miami-Dade County, HHS statistics show.

Justice Department officials moved to freeze money in suspicious bank accounts controlled by medical equipment company owners and they created a Washington-based strike force to handle the issue. The strike force, in concert with a small group of U.S. attorney’s offices, has in the past year opened nearly 900 criminal investigations and convicted 560 defendants in health-care fraud offenses throughout the country.

Authorities say the strategy is working. They point to a $1.75 billion drop in Medicare claims in Miami since the operation began a year ago. But even government officials hope for a more comprehensive solution.

Christopher Dennis, the special agent in charge of the HHS inspector general’s office in Miami, said fraudulent medical equipment companies appear to have shifted gears since the strike force arrived. After a crackdown in South Florida, at least some corporate owners moved to the north, he said. Investigators dubbed one initiative “Operation Whack-a-Mole,” after the carnival game in which a creature pops up in different places after being hit with a hammer.

“The sheer number of zeroes following the dollar sign is irresistible to crooks and con men,” Attorney General Michael B. Mukasey said last month during a Miami visit. “For every crooked company we bust, there is another one to replace it before the ink on the indictment is dry. . . . The money and the temptation are simply too big.”

The strike force recently established a base in Los Angeles, another area rife with fraud. Prosecutors announced criminal charges last month against two medical equipment company owners who are accused of falsely billing Medicare more than $2 million. Plans call for a similar rollout this fall in Houston, another potential fraud hot spot.

“You can see how these frauds spread through communities,” said Kirk Ogrosky, who is deputy chief in the Justice Department’s fraud section and helps lead the strike force. “Family members and friends just get sucked into it. It’s really rags to riches on the backs of the American taxpayer.”

Officials who oversee the Medicare program say they are vigilant despite time pressure and limited resources. Employees review fewer than 5 percent of the nearly 1 billion claims filed each year. The vast majority of claims shuttle through computer systems that are tweaked when authorities notice fraud patterns. This year, CMS is working to finalize a rule that would prevent convicted felons from obtaining Medicare billing numbers. At present, that regulation applies only in a few high-fraud regions.

“It’s a big volume,” Brandt said. “No matter how hard we try to get people trained, there’s always going to be a margin of error.”

Sentenced to 10 years, Campos Ramirez, 60, may yet reduce her prison term by helping authorities unwind “the large web of medical clinics, doctors, nurses, money laundering companies and HIV clinic financiers who participated in this massive fraud,” prosecutors wrote earlier this year in court papers. Her lawyer did not return calls seeking comment.

By many accounts, Campos Ramirez was unusually successful. Prosecutors say that corrupt medical clinic owners anticipate that Medicare will cover a quarter of their phony claims. But Campos Ramirez persuaded authorities to cover 60 percent of all the bills she submitted on behalf of 75 HIV clinics in South Florida, according to court filings.

As the owner of R and I Medical Billing, Campos Ramirez advised clinic owners how to justify the costly HIV treatments and manipulated Medicare claims to make sham clinics appear to be legitimate health-care facilities, prosecutors said. She personally collected more than $5 million with which she bought property and luxury items. Over the past year, however, Campos Ramirez has met repeatedly with law enforcement agents to unravel the scheme, which ran from 2002 to 2006.

At the time of her sentencing in March, Campos Ramirez had amassed a net worth of $1.5 million, including one of the condominiums where her son, an employee of her billing company, had lived.

 

Dublin Doctor Defrauds Medicare, Medicaid, Gets Four Years Probation For Health Care Fraud

Source: rockbridgeweekly.com

Acting United States Attorney Julia C. Dudley announced today that Dr. Linda Sue Cheek, age 59, of Dublin, Virginia, was sentenced yesterday in United States District Court for the Western District of Virginia in Roanoke for defrauding Medicaid and Medicare.

“These taxpayer-funded health care programs are designed to allow our friends and neighbors who are in need of medical care, the opportunity to obtain it,” Acting United States Attorney Julia C. Dudley said today. “When physicians like Dr. Cheek take advantage of these programs in order to get rich, it is our job to hold them responsible for their actions.”

Cheek was sentenced to serve four years of probation for her role in a scheme to knowingly and willfully defraud the Medicaid and Medicare health care programs for her own personal, financial gain. In February Cheek pled guilty to one count of health care fraud, admitting that she had been stealing from the two programs from January 2002 to March 2006.

In addition, Cheek was ordered to pay a total of $24,210.37 in restitution to Medicare and Medicaid and will be required to serve 600 hours of community service in a non-medical field. As part of her sentencing, her license to practice medicine was also revoked.

The defendant, who was a licensed physician by the Commonwealth of Virginia, operated New River Medical Associates, Inc. located in Dublin, Virginia. The facility operated primarily as a pain management and alternative medicine practice.

Cheek previously admitted that between January 2002 and March 2006 she submitted a series of false Medicare and Medicaid claims relating to her medical practice, including the practice of billing Medicaid and Medicare for services she had not performed.

In addition, Cheek admitted to billing Medicaid for services she claimed to perform herself that were, in fact, performed by one or both of the two nurse practitioners employed by New River Medical Associates. Cheek admitted that during many of these procedures she was out of the office and, at times, out of the country.

Finally, Cheek admitted to billing Medicaid and Anthem Blue Cross Beneficiaries for individual treatments called “cleansing sessions,” an investigational service. These “cleansing sessions” were performed and billed as regular, individual office visits but were carried out in a group setting. Medicaid, Medicare and other insurance providers do not allow medical professionals to bill for group sessions.

This case was investigated for the United States Attorney’s Office, Western District of Virginia by the Virginia Attorney General’s Medicaid Fraud Control Unit, the Internal Revenue Service, the U.S. Department of Health and Human Services, Office of Inspector General, the Virginia State Police Drug Diversion Unit and the Financial Investigation Unit of Anthem Blue Cross Blue Shield.

Assistant United States Attorneys Patrick Hogeboom and Charlene Day prosecuted the case for the United States.

 

Feds in Indy seek $789K from medical supplier

May 23, 2008. IndyStar.com

A lawsuit filed by the federal government in Indianapolis accuses a medical products supplier based in northeastern Illinois of falsely billing Medicare for $789,579 in medical equipment.

The government claims Criterion Medical Corp. of Braidwood, Ill. submitted 1,427 false claims between May 2002 and October 2007, billing the government for knee and calf replacement liners.

A government investigation determined those liners were not medically necessary and that Criterion acted recklessly.

The government seeks reimbursement and unspecified damages.

Attempts today to reach Criterion were unsuccessful.

Although the company has an active Web site, phone numbers listed for Criterion are disconnected.

The billings were for Medicare patients in Indiana.

 

Dealing with Medical Billing Errors

Submitted by Nicole Wilson on May 9, 2008 – 5:00pm

Medical billing errors may sound innocent; however, these so called mistakes may be just another way for either doctors or billing agencies to make some extra money. Filing false claims and double billing can be big trouble for the medical industry with the serious charge of fraud.

According to Medlaw.com a Michigan psychologist plead guilty for filing false claims with both insurance companies and Medicare. He was said to have filed $853,000 false claims.

Other doctors that commit this crime may double bill for procedures and doctor visits. They also will pad the bill with procedures they did not complete. The medical offices will defend that it is difficult to come up with the correct codes for appropriate billing to insurance and Medicare. It can also be difficult getting paid for honest claims that are not fraud they argue.

I was always under the impression that doctors were generally honest and that they mean well. I guess I wouldn’t have been so irked if it didn’t happen so often. My personal experience with billing errors has happened not once but five times in just the past couple of years. Since we have major medical and very little coverage we get to pay the majority of the bills. Doctor visits are not covered, so I always pay for the doctor visit up front.

The first time this happened was with a surgery for a lump that was removed. We paid the doctor visits with a credit card at the doctor’s office. A couple months later a bill for what we already paid for showed up in our mailbox. We talked with the accounting person in the office, and they were actually good about correcting this medical billing error.

The second time we had a medical billing error was when I had to go to registered dietician. They were so wonderful to have a pay up front before the doctor visit for the cash patients. They also took my insurance card, they insisted upon it, and I told them that my doctor visits are not covered. The service provided by the dietician was wonderful and helpful. But around 5 months later we receive a bill in the mailbox saying that we owed for the visits that we already paid for! What got tedious with this one was an intermediate medical billing company that didn’t answer their phone calls. I called the regular office, and they gave me the run around. Needless to say, I had to leave several messages on the billing offices machine to get anywhere. I finally got the problem straightened out, but both the doctor office and the billing office had no concern to fix the problem, unless they knew I was going to be calling them every single day for the rest of their lives. The problem did get resolved. But it really was annoying that I had to prove my innocence even though I paid for the visits up front.

The third time I encountered a medical billing error was at a different procedure for a biopsy. This time the insurance company gave a discount. They sent a statement for the allowed amount that the biopsy could be charged for and what part I was to pay. The office that did the biopsy sent the bill but it was over $200 when the allowed amount was only $40. I wrote a letter with the bill and sent a copy of the insurance paperwork and paid the correct amount. They never sent another bill after that. But I started to wonder how many people will pay the full price and never look at the other information sent by the insurance company.

The fourth time that I had a medical billing error was when I had to get an ultrasound done. This time the lab decided to pad the procedure with an additional ultrasound that they never did! I called the office up and had to explain that I did get the one ultrasound but not the other. The extra ultrasound that never happened was an additional amount of $280. I was happy that this time, they fixed the problem fairly quickly.

The fifth time that I have experienced this mysterious medical billing error was a bill that I had already paid for and have received another bill saying that they haven’t received payment. They cashed the check, and I have the copied check that I have mailed, faxed, and called them about. They have a medical billing agency too, and I first left a message but, no calls came back. So I faxed them and called them and got through to that person assigned to your bill. They assured me that they will not send the bill to collections and that it will take a bit of time to figure out. By now, after it being a regular thing these medical billing errors, I have lost my patients with the hours that I have to put into correcting them.

I haven’t had every single bill go this way. I will think twice about going back to those offices that I had these problems with in the first place. I don’t want to go through the headache again! If you have PPO you can shop around a little bit more than the dreadful HMO.

So the moral of the story is if I am just one individual that has encountered numerous medical billing errors, I would suspect that this is common practice and that there are a lot of individuals that are overpaying for their medical services. Since it is a fraudulent activity I would think that the medical billing offices would have absolutely no chance for medical billing errors.

Take your time and don’t be afraid to speak up if you do find a medical billing error. It is your hard earned money. I believe that doctors deserve what is fair and agreed upon and anything not completed or over billed is just wrong.

– by Nicole Wilson

 

Doctor’s fraud totals $3 million, prosecutors say

By Scott MacKay

Journal Staff Writer – The Providence Journal PROVIDENCE — Federal prosecutors are seeking $3 million from Dr. Tarek W. Wehbe, an internist with the Renaissance Medical Group in Providence, who the federal government accuses of fraudulently billing Medicare, Medicaid and private insurers for services he did not perform.

Wehbe, who had his license suspended last week by Rhode Island Health Director Dr. David R. Gifford, is accused of billing for services he didn’t perform, inflating the type of treatment he provided and billing for days consisting of more than 24 hours.

The complaint filed in U.S. District Court in Providence asserts that Wehbe billed for visits and treatments that, if performed properly, would have taken more than 24 hours in a single day. For example, Wehbe billed for 87 patient visits on March 7, 2006, according to the complaint. According to federal standards, the time needed to see that many patients would have been more than 30 hours.

On other days, the complaint alleges, Wehbe billed for 28, 27 and 23.6 hours of visits in a single day.

Federal prosecutors also say that Wehbe fraudulently billed for infusion of the drug Remicade, which is used to treat Crohn’s disease and rheumatoid arthritis, and for treatments with drugs such as Paclitaxel and Gemzar, which are used to treat cancer.

According to the affidavit, between November 2001 and December 2006, suppliers delivered 22,890 units of Remicade to the Renaissance Medical Group, which Wehbe owns. He billed insurers for 39,239 units, or about 16,000 more than he received. The complaint states that from 2002 to 2006, Medicaid, Medicare and private insurers overpaid Wehbe $2.99 million, of which $1.8 million went for infusion drug treatments and $1.1 million for fraudulent office visits and treatments.

Prosecutors are seeking forfeiture of Wehbe’s property and bank accounts. The affidavit states that Wehbe has an account at Citizens Bank and owns real estate at 1630 Mineral Spring Ave., North Providence; 566 East Shore Rd., Jamestown; 6 Pine Tree Lane, Lincoln, 15 Dennell Drive, Lincoln; and 78 Farnum Pike, Smithfield.

Along with the U.S. Attorney’s office, other agencies involved in the investigation include the U.S. Department of Health and Human Services, the Internal Revenue Service, the U.S. Food and Drug Administration and the Rhode Island attorney general’s Medicare fraud control and patient abuse unit.

Wehbe, 43, has been under investigation by state and federal agencies for alleged health-care fraud and medical negligence since a raid at his office in December 2006. When the state suspended Wehbe’s license on April 7, Gifford, state health director, used his power to pull a doctor’s license without a hearing if a physician is deemed to be an immediate danger to the public.

That suspension was prompted by the discovery that Wehbe’s records of purchases of chemotherapy drugs did not match the amount he billed insurance companies. “In reviewing the records, it doesn’t appear that he could have given what he billed for,” said Dr. Robert S. Crausman, chief administrative officer for the state Board of Medical Licensure. “That could be just billing fraud but it leaves open the possibility that patients didn’t get what they should have gotten.”

Most of the affected cancer patients left Wehbe’s practice in December 2006 after he agreed to stop offering infusion therapy at his office after the investigation started, Crausman said. At the time, investigators were concerned about his treatment of patients who had rheumatoid arthritis, hepatitis C and fibromyalgia. When the cancer treatment issue came to light, the medical board considered the matter more serious and recommended that Gifford immediately pull Wehbe’s license, according to Crausman.

The state attorney general’s office is following up to determine if there was abuse of patients, said spokesman Michael Healey.

smackay@projo.com

 

Big Sentence for Medicare Fraudster

April 03, 2008 02:59 PM ET | Luke Mullins

Rita Campos Ramirez, a 60-year-old Miami resident, received a 10-year prison sentence for her role in a multimillion-dollar Medicare fraud scheme. The $170 million scheme is the program’s largest individual case of fraud ever. The sentence was announced Wednesday.

As part of her punishment, Ramirez will also have to hand over her three homes and a car. Plus, she was ordered to pay $105 million in restitution to the federal government.

“The sentence in this case dispels the myth that white-collar-crime defendants get off lightly,” FBI Special Agent in Charge Jonathan Solomon said in a press release. “It reinforces the message that healthcare fraud—stealing from U.S. taxpayers—is a serious crime.”

Details of the crime:

Campos pleaded guilty on Aug. 28, 2007, to one count of conspiracy to commit health care fraud and one count of submitting false claims to Medicare. As part of her plea, Campos admitted that between October 2002 and April 2006 she owned and operated R&I Medical Billing Inc., a medical billing company that specialized in submitting bills to the Medicare program on behalf of HIV infusion clinics. Campos admitted that she knowingly submitted approximately $170 million in fraudulent medical bills to Medicare on behalf of 75 HIV infusion clinics in Miami-Dade County that were part of the scheme. Infusion clinics serve HIV patients by providing prescribed medications intravenously.

The Medicare program paid approximately $105 million of the $170 million in fraudulent bills submitted by Campos, with Campos personally receiving $5 million for her role in the fraud.

Full press release is here.