Even as prosecutions rise, Medicare fraud often runs rampant

Despite some recent successes in combating fraud, Miami continues to be ground zero in Medicare fraud, as criminals morph their schemes to stay ahead of the law, a key South Florida enforcement agent told a Senate panel Wednesday.

Brian Martens, assistant special agent in charge based in Miami for the government’s Medicare agency, said that fraud schemes quickly evolve – and that as enforcement efforts target certain ones, others pop up. They switch between different parts of the Medicare program, they move from area to area, and they often rely on the muscle of organized crime.

“The criminals committing these crimes are often dangerous and we regularly encounter stockpiles of weapons when we execute arrests and enforcement operations,” testified Martens, who works for the inspector general at the Department of Health and Human Services, which oversees Medicare. “These criminals are taking advantage of those most vulnerable in our society – the elderly and the disabled.”

Martens was speaking to the Senate Special Committee on Aging about federal efforts to combat Medicare fraud, which the committee said is estimated to cost taxpayers $60 billion to $90 billion each year. Common tactics: paying kickbacks to recruiters for finding patients and providing unnecessary services.

One particularly shocking case cited by the committee was in Michigan last year, where a physician was arrested for bilking $225 million from Medicare by falsely telling patients they had cancer and then billing for chemotherapy treatments.

Sen. Bill Nelson, a Florida Democrat who chaired the hearing, said, “We can’t afford to lose this much of taxpayers’ hard-earned dollars to fraud, and it’s clear we can’t arrest our way out of a problem of this magnitude.”

South Florida – and Miami specifically – has long been a hot spot for Medicare fraud. Martens said the government has seen criminal prosecutions and monetary recovery increase while payments for certain kinds of fraud have decreased. He cited a drop in payments for community mental health centers that followed special enforcement actions. Following the attention, nationwide Medicare payments for the centers fell from an annual $273 million to $31 million, he said.

But combating fraud is often a game of Whac-a-Mole, with attention focused on one type of fraud prompting the criminals to target different areas.

“I’m just very concerned . . . that Medicare fraud has become a game of catch me if you can – and if you do catch me, it’s just the price of doing business,” Sen. Elizabeth Warren, D-Mass., said at the hearing. “You pay a few million, maybe even a billion dollars. But pay a fine and move on, and alter your business practices only to the extent of figuring out where to minimize the odds of getting caught. If that’s the case, we’re always going to be behind on Medicare fraud.”

Martens also said his unit was in need of more resources. “We don’t have the staff that we need with the amount of fraud that goes on,” he said.

The hearing came as the prosecutions of health care fraud reached a new high, according to data highlighted by the committee. The data analyzed by TRAC, a research organization at Syracuse University, found that prosecutions of health care fraud reached a new high in fiscal 2013.

The data, originally from the Justice Department, also ranked the nation’s 94 federal judicial districts on their prosecutions under the nation’s health care fraud law. The data were analyzed on a per capita basis.

Leading the way, with 10.1 prosecutions per million people, was the Southern District of Illinois, in East St. Louis. Second was the Southern District of Florida, in Miami, and third was the District of South Carolina.

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