KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Massive Medicare Fraud Case Highlights Miami’s Increased Enforcement

Eight defendants were indicted in a massive Florida Medicare fraud case. The Associated Press reports: "It may be the center for Medicare fraud, but even Miami officials said Tuesday they were surprised by the breadth of a ring they say spanned five states, used 29 fake storefronts and attempted to steal $100 million from Medicare and Medicare Advantage. Eight defendants were charged in the elaborate scam authorities say billed Medicare for bogus HIV and cancer infusion drugs using dozens of storefronts in Florida, North Carolina, South Carolina, Georgia and Louisiana, authorities said. Two of the defendants and about $30 million are still missing." The AP notes: "It shows Miami's stepped up health care fraud task force is working. They've prosecuted $1.5 billion in health care fraud cases in the past three years. Miami alone has had 146 convictions since 2007 in these cases. The fact that the suspects had to move to other states and other avenues of Medicare - in this case, Medicare Advantage - signals an understanding on the streets that officials are on to their old tricks."

The AP reports: "Medicare Advantage allows the elderly and disabled to get benefits through private health insurers. The plans receive a government subsidy and generally offer more benefits than traditional Medicare. In most health care fraud cases, the money is easier to track because there's a bank transfer. Authorities say the group owned two check cashing stores, netting between $30,000 and $80,000 in cash several times a week. They fronted through bogus medical clinics around the Southeast." The AP notes: "Last month, U.S. Attorney General Eric Holder announced the federal government would step up health care fraud efforts nationally, increasing the budget by 50 percent to $311 million in 2010 and adding manpower to task forces in Miami, Los Angeles, Houston and Detroit. Tuesday's indictment was one of the quickest health care fraud turnarounds, with about two months lapsing from the tip to the indictment" (Kennedy, 6/23).

The Miami Herald: "Since 2005, the U.S. attorney's office in Miami has charged about 800 suspects for filing a total of $2 billion in phony claims - accounting for one-third of all Medicare fraud cases brought nationwide. Of those defendants, about 60 are fugitives who have fled to Cuba, Latin America and Europe. The latest indictment comes as the Obama administration pushes to fight billions of dollars in Medicare fraud as part of healthcare reform that aims to include coverage for more than 40 million uninsured Americans ... Detroit is the latest city afflicted by Miami-style Medicare fraud, including HIV, medical equipment and home healthcare scams" (Weaver, 6/23).

Reuters: "The 20-count indictment alleges that defendant Michel De Jesus Huarte set up six purported clinics in the Miami area, recruiting straw owners whose names would appear on the paperwork. They were paid large sums of cash with the understanding they would flee to Cuba if necessary to avoid capture, the indictment said ... If convicted, they would face up to 10 years in prison on each count of conspiracy, healthcare fraud and money laundering, and up to two years in prison for each count of aggravated identity theft. The government is also asking for forfeiture of the ill-gotten profits" (Sutton, 6/23).

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