In Medicare fraud, scam patients get unnecessary drugs

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Hope the tiny works, Kathy

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In Medicare fraud, scam patients get unnecessary drugs

By Kelli Kennedy

THE ASSOCIATED PRESS

12/25/2008

MIAMI — Three days a week, Philip Audette sat in a cushy white chair at the

St. Jude Rehab Center, a needle pumping HIV drugs into his arm. He talked and

laughed with a dozen other patients, all in good health, all receiving drugs

they didn't need. All for the money.

Audette says he made $100 to $200 every visit, nearly $10,000 over several

months, selling his Medicare number to the clinic's three owners, the Benitez

brothers, who were later indicted on charges of bilking $119 million from

Medicare.

Authorities say there are thousands in South Florida like Audette, and federal

officials say they play a large role in the fraud overwhelming the national

Medicare system. While authorities are successfully cracking down on clinic

owners, they disagree over whether prosecutors should go after the patients who

get phony treatments in addition to the clinics that provide them.

" Unless patients are prosecuted, we will not have a true long-term impact, " says

Kirk Ogrosky, deputy chief of the U.S. Justice Department's criminal fraud

section and an advocate for arresting patients, something that rarely happens in

Miami and Los Angeles, the two cities where federal health care fraud task

forces are based.

Florida health care providers, mostly in Miami, submitted $2.5 billion in AIDS

treatment claims in 2005, compared with $978 million for the other 49 states

combined, according to a 2007 report by the federal government.

About 8 percent of the nation's HIV/AIDS patients live here, but Florida is

responsible for 72 percent of Medicare spending on the disease — mostly for

dubious infusion therapies such as Audette received.

" It was very easy — the worst part was getting the needle, " said Audette, 48,

who says he is HIV-positive. Audette, who was not prosecuted, testified in court

against a clinic operator.

For years, federal officials aggressively have campaigned against clinic

operators like the Benitez brothers.

But the unspoken thousands who keep these mills churning — the patients —

remain free to move from clinic to clinic, scam to scam, from durable medical

equipment and HIV infusion therapy to home health care. Another year, another

disease. One patient was responsible for claims of $1.1 million for HIV infusion

drugs and other services. Within a few years, the patient had claims filed for

$1.4 million for medical equipment, records show.

But U.S. Attorney R. Acosta in Miami believes it's better to spend his

prosecutors' limited time and resources going after the providers; juries are

often sympathetic to elderly and terminally ill defendants, even if they are

guilty.

Patients, mostly Cuban-Americans, are recruited by brokers who go door-to-door,

offering hundreds of dollars for use of their Medicare numbers, a tactic The

Miami Herald first reported.

Audette says a friend hooked him up with the Benitez brothers about five years

ago. He and other patients were bused three days a week to the Miami clinic.

The Benitez brothers, who owned St. Jude and 10 other clinics, bought hotels,

helicopters, boats, even a waterpark with their spoils and allegedly fled to

Cuba, where authorities believe they remain. A doctor found guilty in the scam

was sentenced to 30 years in prison last week, one of the stiffest penalties

ever imposed for Medicare fraud.

The Justice Department says Miami could significantly alarm bogus patients just

by arresting one a month.

Write a letter

[Guest guest]

These kind of scams are what is undermining the capability to fully

fund the necessary Medicaid Waivers.. to get people off of waiting

lists.. Medicare Reform is a MUST.

E. , Sr. The Office of Advocacy

>

> http://www.stltoday.com/stltoday/news/stories.nsf/nation/sto

> ry/E7C672867EF122A68625752A000BB84A?OpenDocument

>

> Hope the tiny works, Kathy

>

> http://a7rvyk

>

> In Medicare fraud, scam patients get unnecessary drugs

> By Kelli Kennedy

> THE ASSOCIATED PRESS

> 12/25/2008

>

> MIAMI †" Three days a week, Philip Audette sat in a cushy white

chair at the St. Jude Rehab Center, a needle pumping HIV drugs into

his arm. He talked and laughed with a dozen other patients, all in

good health, all receiving drugs they didn't need. All for the money.

>

> Audette says he made $100 to $200 every visit, nearly $10,000 over

several months, selling his Medicare number to the clinic's three

owners, the Benitez brothers, who were later indicted on charges of

bilking $119 million from Medicare.

>

> Authorities say there are thousands in South Florida like Audette,

and federal officials say they play a large role in the fraud

overwhelming the national Medicare system. While authorities are

successfully cracking down on clinic owners, they disagree over

whether prosecutors should go after the patients who get phony

treatments in addition to the clinics that provide them.

>

> " Unless patients are prosecuted, we will not have a true long-term

impact, " says Kirk Ogrosky, deputy chief of the U.S. Justice

Department's criminal fraud section and an advocate for arresting

patients, something that rarely happens in Miami and Los Angeles, the

two cities where federal health care fraud task forces are based.

> Florida health care providers, mostly in Miami, submitted $2.5

billion in AIDS treatment claims in 2005, compared with $978 million

for the other 49 states combined, according to a 2007 report by the

federal government.

>

> About 8 percent of the nation's HIV/AIDS patients live here, but

Florida is responsible for 72 percent of Medicare spending on the

disease †" mostly for dubious infusion therapies such as Audette

received.

>

> " It was very easy †" the worst part was getting the needle, " said

Audette, 48, who says he is HIV-positive. Audette, who was not

prosecuted, testified in court against a clinic operator.

>

> For years, federal officials aggressively have campaigned against

clinic operators like the Benitez brothers.

>

> But the unspoken thousands who keep these mills churning †" the

patients †" remain free to move from clinic to clinic, scam to scam,

from durable medical equipment and HIV infusion therapy to home health

care. Another year, another disease. One patient was responsible for

claims of $1.1 million for HIV infusion drugs and other services.

Within a few years, the patient had claims filed for $1.4 million for

medical equipment, records show.

>

> But U.S. Attorney R. Acosta in Miami believes it's better

to spend his prosecutors' limited time and resources going after the

providers; juries are often sympathetic to elderly and terminally ill

defendants, even if they are guilty.

>

> Patients, mostly Cuban-Americans, are recruited by brokers who go

door-to-door, offering hundreds of dollars for use of their Medicare

numbers, a tactic The Miami Herald first reported.

>

> Audette says a friend hooked him up with the Benitez brothers about

five years ago. He and other patients were bused three days a week to

the Miami clinic.

>

> The Benitez brothers, who owned St. Jude and 10 other clinics,

bought hotels, helicopters, boats, even a waterpark with their spoils

and allegedly fled to Cuba, where authorities believe they remain. A

doctor found guilty in the scam was sentenced to 30 years in prison

last week, one of the stiffest penalties ever imposed for Medicare fraud.

>

> The Justice Department says Miami could significantly alarm bogus

patients just by arresting one a month.

>

>

> Write a letter

>