Posted on 11/20/2014 2:56:26 AM PST by Cincinatus' Wife
As Medicare rackets go, authorities say, this one had no borders.
Eleven people associated with a South Florida managed care company were charged Wednesday with fleecing Medicare for services provided to U.S. citizens while they were living in Nicaragua and the Dominican Republic, according to an indictment.
Coral Gables-based Florida Healthcare Plus filed false bills for retired Medicare beneficiaries who claimed to be living in the state but were being treated by foreign doctors while they resided in the two Latin American countries. That is illegal under the federal taxpayer-funded program for senior citizens and the disabled, authorities said.
Eight of the defendants, including a physician, were arrested Wednesday. The remaining three offenders are in Nicaragua.
The defendants are accused of defrauding Medicare and the parallel state Medicaid program for low-income people.
All together, the defendants raked in $25 million in the transnational fraud scheme between 2011 and 2014, Assistant U.S. Attorney Eric Morales said. The investigation, led by the FBI and Health and Human Services’ Office of Inspector General, is believed to be the first of its kind in South Florida, the nation’s capital of healthcare fraud, and in the United States.
“Unfortunately, scams that bilk our healthcare system do not stop at our borders,” said George Piro, special agent in charge of the FBI in Miami.
“Providing Medicare services in foreign countries but billing as if they occurred in the United States is in-your-face fraud,” said Derrick Jackson, special agent in charge of HHS-OIG’s office in Florida.
(Excerpt) Read more at miamiherald.com ...
Had to go get some prescriptions filled Tuesday. While he (doctor) was writing them out I asked him, “So Doc, I’m going on Medicare in January. Are you gonna drop me? He said “No, I won’t - Medicare pays the best, less problems and quibbling.” “The only insurance which comes close is Blue Cross/Blue Shield but it still isn’t as good as Medicare”
scams that bilk our healthcare system do not stop at our borders,”......So, we don’t have a “system”, I can see.
So the people living abroad really did receive the services, and the billing company actually paid their doctors?
Do they have executive order amnesty yet??
The Dominican Republic has a vise-like stranglehold on the US, its politicians and our finances. This has to end.
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NJ Sen Menendez' donor---a Florida Doctor With Big Medicare Billings Is No Stranger to Scrutiny
The South Fla doctor who billed Medicare for $21 million in 2012 alone, is a generous political donor to NJ Sen Robert Menendez, now under investigation by federal public corruption prosecutors.
The millionaire surgeon, lives luxuriously in North Palm Beach, Fla, and travels by private jet, to his luxe villa in the Dominican Republic.
Menendez took free rides on the doctor’s private jet and stayed at his luxury resort villa in the Dominican Republic. The senator was forced to pay back the cost of the travel under scrutiny. Melgen donated over $700,000 to Menendez's PAC......Menendez made calls on the Melgen’s behalf to HHS when Melgen was beset with overbilling allegations.
Menendez used his Senate office to advocate on behalf of the doctor---Menendez called a special Senate hearing into the doctor's port security contract in the Dominican Republic.
The hearing involved a port security company that Dr. Melgen had purchased in the hopes that the Dominican Republic would start screening every container on every outbound vessel. The Customs agency refused to honor the contract; Sen Menendez urged US officials to get involved.
Without mentioning his friend, the senator used his powerful position to urge federal agencies not to donate free port equipment that would have competed with the doctor’s business plans. Dr. Melgen and his family in the Dominican Republic are powerful members of the political establishment. Dr. Melgen co-founded Voxxi, a Hispanic-oriented news site, which has published laudatory articles about the doctor and the Senator. (Excerpt) Read more at nytimes.com ...
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Florida resident Melgen (under investigation for govt fraud) paid $30,400 for the privilege of co-hosting a 2009 fundraiser for Democrats' DSCC committee then-headed by NJ's Menendez.
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Menendez must be sweating bullets----ace WNBC reporter, Jonathan Dienst, did the towering investigation of NJ Sen Robert Torricelli which forced the crook out of office.
Dienst himself has said "....the investigation of Senator Torricelli’s alleged corruption was an extraordinary exercise in journalism; going out and spending about six months on that story working almost non-stop digging and digging, trying to find corroboration to allegations that the senator had an improper relationship with a convicted felon."
" So we were out meeting with merchants, meeting with defense lawyers, meeting with investigators, members of Congress, and meeting with anyone who might have information about the senator’s alleged wrong doing."
"We obtained documents, tapes and materials and it was at a very important time. The election was coming up, the balance of power weighed in the balance and the fact that we were able to show and highlight some of the senator’s activities so that the voters knew. That was an incredible story to be a part of."
If Medicare did such a good job of paying doctors, then why are there signs up NO NEW MEDICARE PATIENTS in so many doctors offices. Medicare does not quibble they have a set formula for reimbursement. And doctors know it. Even a set number of days for a hospital stay, you may still be sick and need more time, good luck getting it approved and paid for.
A routine Internist visit is $85 with the blood draw, between Medicare A/B and Tricare Life (Ret. Military over 65) as secondary. He might get lucky and get and see $55.
Pharmacies take the worst beating. Even on generics. And now all Tricare Life are DOD MANDATED get their daily prescriptions from Express Scripts or drive to the nearest Military Base pharmacy, which are limited in the drugs they carry. Base requires a paper script, might take up to 24 hrs to fill, refills come out of Pensacola take 5 days. ES takes 3 weeks for first fill, 2 weeks refills. They just shove thousands of $$ in meds in your unlocked, mail box, UNSIGNED for. It will, I am told by my US Rep take an act of Congress to get this asinine procedure fixed so it is Photo ID signed for.
Meanwhile your meds are subject to theft, kids getting them.
Only exception is a 1 time fill script, an antibiotic for a sudden infection then you can use your local pharmacy.
Slow reimbursement, low reimbursement are the most common cause of doctors not taking New Medicare patients. It can be up to 3 months before they are paid.
I was only reporting what he said. I did not say I agreed with it. It seems to me he must be dealing with a preponderance of patients that either have ObamaCare (not Medicaid or Medicare) and/or low-tier insurance companies.
Also, it is not an apples/apples comparison when you bring Tricare into the mix, IMO. Lastly, as far as Express Scripts is concerned, I’ve dealt with them and it is an organization full of idiots and losers if you ask me. I never could get it right with them.
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