Rx for Plunder

On a crisp February morning in 2003, Dr. Evan Zimmer, dressed in jeans and a Hawaiian shirt, rolled up to work at the Oakland Community Health Center in Fort Lauderdale.

"I see this guy in Dockers hanging around the back door," Zimmer recalls. The man seemed to be guarding the place. Instantly, Zimmer sensed something wrong. "It was like getting a certified letter."

The man brusquely put his hand on the doctor's shoulder and escorted him inside — where a slew of FBI agents, pistols clipped to their belts, were dismantling computers and stashing files in boxes. They were seizing the health center's financial and medical records.

Zimmer's colleagues were nowhere in sight. He was shuffled into a small backroom. "It was very intimidating," he says. "I figured I was just a dead duck."

FBI agent Catherine Nazworth greeted the doctor with all the warmth of a hungry drill sergeant. Long, jet-black hair did nothing to soften her look. She stared Zimmer down. "This is your only chance to come clean," the psychiatrist remembers her saying.

His pulse racing, his brain in shock, Zimmer prepared to confess every mistake he'd ever made, starting from kindergarten.

There was little doubt about it: At the Oakland Community Health Center, laws had been broken. In seven years of operation, the program had scooped up $9.8 million in federal Medicare funds, ostensibly to provide outpatient care for mental health patients. Federal agents found that Oakland staff had routinely hyped results and submitted spurious reports. They also found that Oakland was, from top to bottom, a nest of nepotism, with family members not only directing the program but also providing contractor services.

Since Medicare was created in 1965 for the elderly and disabled, millions have benefited. A vast $400-billion-a-year system now providing health care to about 43 million beneficiaries, Medicare has also become a target for an array of rip-off artists, from medical equipment suppliers who don't deliver to "Medicare mills" that charge the government for treating nonexistent patients.

Oakland was a small-time player in the Medicare game. But the prosecution of directors and staff members by federal authorities offered a rare inside glimpse of how seemingly nice people can get swept up into a system in which money comes so easily that it's hard to say no.

Medicare fraud — which, according to those familiar with the system, is remarkably easy to commit — has come to cost taxpayers billions each year. But investigators and prosecutors say they are catching on, going after big and small abusers. These days, the feds are in serious chase mode, especially in Florida, where Medicare pumps out billions in benefits.

According to friends and family, Oakland Community Health Center's director, Bernard Graves, was a handsome man who grew up in Key West and moved to Broward County to work as a probation officer. Glasses perched on his nose, his hair pulled back into a ponytail, he exuded control and confidence. His wife, Althea Richards, with her smarts and strong will, had caught Bernard's eye while she was still a student at Piper High School. Both Bernard and Althea seemed to have an eye for opportunity.

By the mid-1990s, the couple had realized that health care wasn't a bad way to make a living.

It's expensive to stick a person in a mental hospital. To reduce hospital costs, Medicare established the Partial Hospitalization Program to serve patients who suffer from acute illnesses but don't quite need 24-hour care at a hospital. People with profound mental health conditions could get intensive treatment at a Community Mental Health Center (CMHC) during the day and still return home at night.

As the indictment that would later charge the Graveses with 43 counts of criminal wrongdoing notes, Medicare would foot the bill for CMHCs only under certain conditions: Patients must need treatment due to "a mental disorder that severely interfered with multiple areas of daily life." However, they needed to still have "the mental and physical capacity to have actively participated in all phases of the program." The treatment needed to be "vigorous and proactive as opposed to passive and custodial," and Medicare required "a reasonable expectation of improvement of the patient's disorder" as a result of the program. A doctor was required to certify the need for the treatment, and the CMHC was expected to maintain detailed records on site.

Opening a CMHC must have looked like a golden idea to Bernard and Althea. There were no educational requirements. Doctors and therapists could simply be hired. Once the paperwork was approved and an inspector OK'd the facility, voilà! — they'd be issued a provider number and could start billing Medicare.

Bernard would become the administrator of the Oakland Community Health Center and Althea the assistant administrator. They would bring on Althea's mother, Yvonne Howell, a registered nurse who ran four nursing homes, as clinical director. According to those familiar with the case, Bernard did not disclose his 1995 felony conviction for marijuana possession or his arrest for driving on a suspended license the following year.

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Deirdra Funcheon