Gonzalez teamed up with assisted-living facilities full of residents suffering from retardation and dementia. In exchange for kickbacks, operators of these facilities would bus in all their patients; Gonzalez would collect each of their individual Medicare card numbers and bill Medicare for services the "patients" weren't eligible for or never received.
By the time the feds started sniffing around in 2008, Gonzalez had made off with $28 million, enough to fund a personal fleet of 17 luxury vehicles. He closed shop in Miami only to reopen in North Carolina. When he was finally arrested last year, Gonzalez was planning to expand into Tennessee. He pleaded guilty in December.
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.