Wednesday, May 14, 2008

Puerto Rico......US healthcare dollars ripoff occurred in Puerto Rico

Alleged Medicare fraud in Puerto Rico burns nearly 1 million US tax dollars; billions lost in other fraud
The latest alleged US healthcare dollars ripoff occurred in Puerto Rico, to the tune of $922,882.00. On May 1st, a grand jury returned a 27-count indictment charging four doctors and two other individuals with conspiracy, health care fraud, soliciting and receiving kickbacks in relation to the Medicare Program, false statements and forfeiture allegations. This is a drop in the mega bucket of wasted dollars.

Healthcare dollars wasted in virtual barbecue
I’ve often pointed out that if the federal government was a more responsible steward of our tax dollars, the money saved could fill many needs, such as health insurance for the working poor. The alleged Puerto Rican healthcare grifters worked in a similar manner to some Medicaid thieves in South Florida. Government officials say recent reports show as much as $2 billion a year may be lost in Florida’s $16 billion Medicaid program to fraud and abuse. So we’re talking one US government territory and one US state and more than $2 billion in fraud. Take a look at any other state and you’ll find your tax dollars are being burned with pleasure. In New York in 2006, indictments were issued for a Medicaid fraud ring involving a doctor, pharmacists, several city pharmacies, millions in fraudulent Medicaid billings and large monetary transfers to individuals in Pakistan. Sixteen individuals and five corporations have been indicted in the ongoing investigation and a civil action has been filed against twenty individuals and entities freezing assets and seeking the recovery of more than $22 million.

Consider this—these are the fraudulent bucks we know about largely thanks to cooperative investigations among top-notch law enforcement agencies and basically every level, from local cops to the US Justice Dept. Wanna have some fun? Enter the name of any state or US territory in your search bar and add the words, ‘Medicare fraud.’ Have fun and have lunch, dinner and breakfast the following morning while you’re at it. It’ll take you that long to read all the results for Medicare fraud in a single state.Puerto Rican company sold durable medical equipment
In the Puerto Rico case, Doctor's Medical Supplies was a durable medical equipment (DME) company authorized to do business in Puerto Rico with its business office located in Luquillo, Puerto Rico, and registered as an authorized Medicare Part B DME supplier. Doctor's Medical Supplies submitted claims to Medicare, seeking reimbursements for DME, including oxygen services, motorized wheelchairs, and hospital beds, that were allegedly provided and medically necessary. During the time period listed in the indictment, Doctor's Medical Supplies submitted false claims for DME and received approximately $922,882.00 in Medicare reimbursements.

The main defendant, Rabindranaut Amrud-Ríos, also known as Rabin, submitted and caused the submission of false and fraudulent claims to Medicare. He is the owner and president of Doctor's Medical Supplies. Amrud-Rios oversaw the business and financial operations of Doctor's Medical Supplies. The "Physician Signers," as used in the Indictment, would sign prescriptions and certificates of medical necessity (CMNs) and were paid kickbacks by Amrud-Rios to sign the false CMNs. Amrud-Rios along with the other defendants listed in the indictment falsely and fraudulently represented that the medical conditions of the Medicare beneficiaries were such that DME, which included oxygen services, power wheelchairs, and hospital beds, were medically necessary when in fact the Medicare beneficiaries were either dead or did not suffer from such medical conditions and did not qualify to receive the DME under the Medicare regulations.

The names of the four doctors involved in the conspiracy are: Jaime Belardo, Narciso Reyes-Carrillo, José Figueroa-Pacheco, and Rafael Esteva-Heal. Also charged is Gladys Avilés, an employee of Doctor's Medical Supplies. The licensed doctors are charged with signing blank or previously completed false prescriptions and CMNs for Doctor's Medical Supplies. Each of the doctors was paid kickbacks by co-defendant Amrud-Ríos in exchange for signing blank or previously completed false CMNs for Doctor's Medical Supplies. Defendant Gladys Avilés was the employee of Doctor's Medical Supplies who completed blank and false CMNs for Doctor's Medical Supplies and submitted claims to Medicare based on those false CMNs.

Why aren’t the presidential candidates talking about this issue?
Health insurance is a hot topic as our presidential election draws near. Until the feds can manage the money we taxpayers already ante up, I really hope members of congress steer clear of raising income taxes. It’s like the same hope I have to win the lottery—ain’t gonna happen. But I’m already paying for mistakes that can actually be corrected at a basic level. That’s why we have federal government workers. It’s obvious Medicare needs better oversight. Why aren’t the candidates doing something about the fraud that could help those who need healthcare and can’t afford it? Sen. John McCain is a Republican. Here's a wakeup call, GOP—this is an issue handed to you on a silver platter. Especially since we read Sen. Barack Obama’s lips and he guarantees us he’ll raise our taxes. We anticipate he'll have lots of help from the tax loving members of congress.

Why shouldn’t we focus on saving these dollars? Why don't politicians ever talk about it? Because it’s easier to just tax us? What do you think should be done to stop the burning of US tax dollars in healthcare fraud?

--filed by Kay B.Day

Copyright © 2008, Kay B. Day. All rights reserved.

1 comment:

Anonymous said...

Maybe if the government didn't make these doctors wait 6 months to get paid their meager wages for treating their clients who are 90% welfare recipients, they wouldn't turn to this type of thing to be able to pay their bills. I know one of these doctors (who told me he is innocent) and the government always owed him money. He couldn't even pay his staff because of not getting paid for months and months at a time. That's the norm in P.R. The government puts them into a situation of extreme financial desperation and then wonders why they turn to taking kickbacks.