Still, fraud knows no party, race, or gender. Indeed, allegations against state Rep. Daphne Campbell's (D-Miami) clan could script a health-fraud installment of The Klumps.

Campbell ran ten group homes until the state canceled her Medicaid contract in 2006. Four people died in her facilities that year, including one developmentally disabled female patient, who had also been raped. Inspectors found rodent feces and general squalor.

Meanwhile, Campbell's ex-con husband, Hubert Campbell, has been accused by two former partners of defrauding Medicaid (Medicaid is a state version of Medicare and serves the poor and disabled).

Not to be eclipsed, their 28-year-old son, Gregory Campbell, is accused of submitting nearly $300,000 in false Medicare billings while operating adult group homes. He's been charged with felony theft, organized fraud, and Medicaid fraud.

And just last week, Naples check-cashing store owner Oscar L. Sanchez was sentenced to 4.5 years in prison for stealing $10 million from Medicare and siphoning it to Cuba. Sanchez, who is Cuban-American, was allegedly part of a ring that falsely billed Medicare for $374 million.

The culture of fraud stinks to the very head of Florida government.

During the 1990s, the feds prosecuted the largest fraud case in Medicare history against hospital chain Columbia/HCA. The company seemed more organized-crime outfit than health-care provider.

Columbia billed for tests that weren't necessary or ordered, submitted false diagnoses to increase reimbursements, paid kickbacks to doctors for patient referrals, and billed for home visits people didn't qualify for or receive.

The smoking gun was the two sets of books Columbia kept. One detailed all Medicare submittals. The other noted which were fraudulent, allowing Columbia to keep enough reserves to pay penalties should it ever get caught. A whistleblower estimated that fraud alone accounted for more than one-third of the company's profits.

When the whip came down in 2003, Columbia settled for $2 billion in fines for "systematically defrauding federal health-care programs."

The man at the head of this company claimed ignorance and was eventually fired — but with the velvet landing accorded to disgraced CEOs. Rick Scott walked away with nearly $10 million in severance, stocks worth $300 million, and a $1 million-a-year consulting contract. In 2010, he was elected governor of Florida.

Only two lesser executives got jail time. Lead FBI agent Joe Ford would later regret allowing the company to simply pay away its sins: "People need to go to jail."


Florida may be an epicenter of Medicare fraud — but it's a problem all over the country.

At Michigan's Monroe Pain Center, parking lots were filled with cars sporting license plates from Kentucky, Tennessee, and even Florida. That's how far people were willing to drive for a "Las Vegas Cocktail."

The cocktail mixes Xanax, Soma, and Vicodin for a powerful opiate high. Monroe was its unofficial retailer. It was led by Oscar Linares, a doctor from the Dominican Republic. In 2008, the office went from seeing 40 patients a day to as many as 250. Over two years, Linares prescribed 5 million doses of narcotics. Traffic grew so heavy that he hired a parking-lot attendant. Workers got bonuses when the patient count topped 200 in a day.

The cost to Medicare: $5.7 million.

Linares rarely examined his patients. One undercover cop didn't see the doctor until his tenth visit, and only then via a television monitor. Linares' workers simply gathered patients' information and had them sign blank forms that would be filled in later. Then a guy who used to work at Lowe's would hand out the scrips.

When the clinic was raided in 2011, police seized $214,000 in cash, a yacht, and the 55-year-old doctor's fleet, which included a Ferrari Spider and a Bentley Continental. Linares was charged with unlawful distribution of prescription drugs and Medicare fraud. He has pleaded not guilty and is awaiting trial.

A half-hour north, in Detroit's Cass Corridor, amid a stretch of poverty and ruin called "The Beach," shelters provide a steady flow of poor Medicare beneficiaries. Recruiters drink beer and sit on beach chairs — hence the name — wrangling people into vans that shuttle "patients" to doctors, home-health agencies, and mental-health clinics.

Doctors not only bill Medicare and Medicaid but use the power of prescriptions as currency to pay accomplices. It's a multiring circus, with the doctor at its center and kickbacks flowing in all directions, to pharmacies, patients, and recruiters.

"A recruiter will identify a physician and work out a deal, saying, 'I'll bring you so many patients,' and the recruiter will pay a physician $10,000 to $15,000 to write scrips like crazy, pad after pad, for a week," says one Detroit agent.

"When you have a dirty doctor writing 500 scrips for Oxycontin a month, you have to have a pharmacy that is going to fill them. If a pharmacy sees a Dr. ABC's scrip 500 times a month, they will call and ask, 'What's up, Doc?' The recruiter plays a role here too and says, 'I'm taking care of the pharmacy.' "

The scheme has even spawned subspecialties such as "quality assurance" experts. They're typically former doctors from overseas who read through patient charts to flag anything that might prevent Medicare from paying.

And since frauds realize that Medicare auditors see red flags when there's a billing spike from one company, they'll incorporate seven or eight to spread the grift. Some even launch check-cashing businesses to launder their money.

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8 comments
dr.jaya
dr.jaya

This well written article should have beeen published in JAMA and New Engand Journal of Medicine ..

dr. jaya

smdrpepper
smdrpepper topcommenter

Well considering that Rick Scott made millions off this should be telling.

Milord
Milord

Does it surprise anyone that a state that elected a man who made his millions by defrauding Medicare has an increasing problem with medicare fraud? It is high time the people of Florida extruded their crania from their recta and got rid of Gov. Voldemort! Over and over again the voters make the illogical, thoughtless and intelligence-denying choices. 

WAKE UP!

riverrat69
riverrat69 topcommenter

Medicare fraud might be sweet in south FloriDUH, but it buys you the governors seat in Tallahassee.

jefles
jefles

Chris mentions the congressional hearings where Congressman Burgess talks about his credit card and Chick-Fil-A.  At 1:01:28 of the same hearings, Congressman Shimkus holds up a card, that runs through the credit card networks, that would prevent much of that fraud.  I am the guy who invented it, and John Shimkus is holding up a card I gave him to demonstrate that not only is this possible, it works today.  We have proven it. 

frankd4
frankd4 topcommenter

"That's the bread and butter of the fraudster — the fact he can pay somebody to participate in the scheme," says Dennis. "If you have a willing participant, you then eliminate the ability to tie the fraud to you. That person is going to lie for you because they conspired with you."

in the olde dayz a gangster took the newbie with him and at the right time handed the newbie the GUN to do the hit........................voila the newbie was now a co-conspirator

so today the co-conspirator simply has to take money to collude, and collusion is the one thing an auditor cannot design an accounting system to prevent

if these clowns weren't so greedy these overbilling frauds could go on endlessly

frankd4
frankd4 topcommenter

don't just take ONE geographic area since any medical facility anywhere can simply CODE reimburseable medicare and medicaid medical proceedures to maximize revenue generated

the typical geographic area only need those who qualify for such coverage and who can produce a valid social security number = period

i can predict that every second hobo at a random bus station would be a potential profit center - i withnessed one old dude at BCT central terminal went from a walker ($300) every three weeks to a fully equiped wheelchair ($16,875) which he even had pin-striped; otherwise this miscreant didn't have two nickles to rub together

i saw it start myself a dozen or so years ago at assisted-living facilities whereas the home would profit from commissionable sales of goods and services to the qualifying residents who knew nothing of how things were being paid

finally MAIN street has a scam equal to WALL street, in scope and magnitude, which will eclipse even the mortgage meltdown, and certainly reach beyond our governors office, when fully exposed, as to who all the players really are

miami321973
miami321973

Hialeah is third world territory and not part of the United States.

 
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