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National News

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107 Charged In Medicare Fraud Busts In 7 Cities

May 2nd, 2012 4:30 pm Associated Press

MIAMI (AP) — Federal authorities charged 107 doctors, nurses and social workers in seven cities with Medicare fraud Wednesday in a nationwide crackdown on unrelated scams that allegedly billed the taxpayer-funded program of $452 million — the highest dollar amount in a single Medicare bust in U.S. history.

It was the latest in a string of major arrests in the past two years as authorities have targeted fraud that’s believed to cost the government between $60 billion and $90 billion each year. Stopping Medicare’s budget from hemorrhaging that money will be key to paying for President Barack Obama’s health care overhaul.

Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder partnered in 2009 to increase enforcement by allocating more money and staff and creating strike forces in fraud hot spots.

On Wednesday, hundreds of federal agents fanned out around the country, raiding businesses, seizing documents and charging 107 suspects in Miami, Los Angeles, Houston, Detroit, Chicago, Tampa, Fla., and Baton Rouge, La. The government suspended payment to 52 providers as part of the investigations.

“When President Obama took office he asked Attorney General Holder and me to make fraud prevention a cabinet-level priority,” Sebelius said in remarks prepared for a news conference in Washington.

Among those arrested Wednesday were the owners of two community mental health centers in Baton Rouge, charged with billing $225 million in their scams. Hoor Naz Jafri and Roslyn Dogan allegedly recruited vulnerable patients, including elderly people, drug addicts and the mentally ill. Patient charts were doctored to show services that were billed to Medicare but often never given, according to an indictment.

Authorities suspended their companies in May 2011, but the pair continued billing Medicare after purchasing another fraudulent company, according to the indictment. When feds shut down that company, the pair tried to sell their “beneficiaries” to other providers in an attempt to keep making money.

During the investigation, federal authorities tried to put a hold on the company’s bank account. Dogan asked to visit the U.S. Attorney’s Office to review and copy documents that had been seized as part of a search. After the visit, “Dogan and co-conspirators bragged that, while pretending to copy files, they actually stole incriminating documents from the files and later destroyed them.” Dogan referred to herself as a “smooth criminal,” according to the indictment.

Another co-conspirator bragged to Dogan and others that he had a “bonfire with fabricated notes that law enforcement officers had failed to seize during the search,” according to the indictment.

They could face life in prison if convicted. A woman who answered the phone at one of the companies hung up and an email to the company was not immediately returned.

Five others were charged in connection with the Baton Rouge scam, capping a six-year investigation.

“The results we are announcing today are at the heart of an administration-wide commitment to protecting American taxpayers from health care fraud,” said Attorney General Eric Holder. “We are determined to bring to justice those who violate our laws and defraud the Medicare program for personal gain.

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  • howa4x

    We have to revamp the system that rewards doctors for preforming tests and go to a more outcome/reward system that measures patient care. If I can get paid for just testing I can easily defraud the system, because the test is all that is measured. Part of the Afforable health care act that has the conservatives bent out of shape because someone used their own idea, is trying to control costs by looking more at patient outcomes. Right now we have an illness management system, that dosen’t really cure anybody in it, but rather maintains their chronic disease at a level where the patient can contribute to family and work. A good expample is diabetes which is at epidemic levels. The current medical system will keep you on insulin for the rest of your life. Doctors don’t say that to change your lifestyle, loose weight, exercise, remove sugars, will actually cure you, because they can’t make any money doing that and big pharma can’t either. This is the real fraud in this country. It’s amazing that over 100,000. people die a year from the medication not the disease. The doctors and big pharma have become the new axis of evil. They have a great scam going. You go to the doctor because of lifestyle issues, they run a battery of tests which they get paid for, place you on a number of drugs which they and big pharma get paid for, and bring you back every 3 months for more tests, which they get paid for again. If they are lucky you will develop complications from the side effects of the drug and they will prescribe more drugs to deal with that, and get paid each time you are there and each time they prescribe another medication. Big Pharma gets paid every time a new drug is prescribed. At no time during your treatment plan will they refer you to a place like the biggest looser, or the gym. A good example is cancer treatment. Since the war on it started in the 70′s hundreds of millions have been spent on finding a cure, but if you look at outcome rates the needle has only moved slightly and on some cancers not at all. Now they are begining to realize that if they don’t burn, cut or poison the body will heal itself if given the right nutritional support.
    Insurance companies will pay for any drug, or doctor visit you make but will not pay for alternative treatments like accupuncture, massage for muscle pain, or suppliments which the doctors and big pharma always want to ban. The only real medicine that works are antibiotics for communicable disease teatment, trama care and orthapedics if used based on outcomes ie don’t put new knees in a 90 yr old which is more common than you think. This is what the basis of the real fraud is all about, but the prople who are doing it are too politically powerful for anyone to change it, and have convinced the public that it really works.

  • http://www.facebook.com/donald.self2 Donald Self

    this is taking to it to be greedy, thats why ppl on medicade its getting tough on them and its getting tough getting them to pay for any thing paid for