Artificial limbs, but real Medicare fraud
Posted: Friday, December 21, 2007 2:27 PM
By Mark Potter, NBC News Correspondent
MIAMI – While reporting on Medicare fraud – the nationwide theft of an estimated $60 billion a year – we keep running into outrageous examples of just how bad it is. The following data from South Florida, where authorities say the problem is the worst in the country right now, just might take the cake:
Federal law enforcement officials investigating in Miami-Dade and Broward counties found that from 2002 to present Medicare paid for 89,803 artificial limbs.
That many artificial limbs in just two counties? OK, they’re big counties, but experts say it's almost pure fraud, and a disgustingly brazen one at that. As one officials said darkly, "I didn't understand we had landmines down here. This is off the charts."
Sadly, the situation could be even worse. Although $95 million in taxpayer dollars was the amount paid to the people making those outlandish claims, the amount they actually submitted to Medicare in hopes of payment was a stunning $615 million (for a total of 305,935 limbs). In other words, more than $500 million in claims were rejected. A lot of people must have really worked overtime to come up with that many phony bills.
To put it in perspective, we asked the U.S. Department of Defense to tell us how many American service personnel have endured amputations during the full course of the war in Iraq so far. The answer we got back yesterday was 674 through Nov 1 of this year.
Each one of those numbers represents a serious injury and painful suffering on the part of an American hero. Those war-related injuries and treatments really happened, unlike the mostly fraudulent injury and treatment claims that we all financed via taxpayer dollars in South Florida.
For the sake of argument, if we were to say that each one of those 674 service personnel had lost all four limbs, that would mean the total number of arm and leg prosthetics needed would be 2,696 for the entire Iraq war so far. That's a made-up number, of course, and much higher than the actual one, but when you compare it to the 89,803 limbs paid for in the Miami-Ft. Lauderdale areas alone, along with the bills submitted for 305,935 limbs, it really makes the point.
Eventually, officials say, the people responsible for paying Medicare claims caught on to the prosthetics scam and have brought this particular one under control – but only after $95 million in payments went out the door. A little bit of that money went to the many legitimate health care suppliers out there who toil honestly and take a bum rap for all the fraud. Most of that money, though, went to thieves.
Kirk Ogrosky, a U.S. Justice Department prosecutor who specializes in combating Medicare fraud, says it's critically important to identify and stop the fraud BEFORE payments are made, adding, "It is disheartening to believe that in trying to provide independence and dignity to those who have suffered the loss of a limb that the Medicare program has funded the personal extravagances of crooks who believe the American taxpayers serve as their personal piggy banks."
The newest fraud, officials say, involves home health care, where investigators are seeing millions of suspicious bills for services they strongly suspect were never given – things such as three-hour nurse's visit to give one shot.
While you're chewing on all that, think about this: Just this week, Congress CUT from next year's omnibus spending bill a proposed increase of $183 million that was supposed to help fight Medicare fraud.
Read and watch Mark Potter's other investigative stories on Medicare fraud:
Blatant Medicare fraud costs taxpayers billions
Criminals find Medicare easy to defraud
