Why do Fraudulent Providers still exist ? Becasue they can?

Our Government and Lobbyists & FInancial Investment Firms at work, once again!!
That is the real answer. But maybe, for starters, we need to connect dots to the BIG POLICY MAKERS and their connection to FRAUD,i.e. Frist, Bush, Rainwater & Moore!

Go to the NCFE trial in Dublin, Ohio that DOJ would like to behave as this case is over, while the Co-Founder and a 3uear EXECUTIVE, James K Happ, has yet to go to trial? Now , you ask how this is connected........??????
http://biggerthanenron.blogspot.com

Now wwhy do you think this is?"...states submitted incomplete data or reported not taking any action against health care providers in 2004 and 2005."

"...In violation of federal law, states routinely fail to notify federal authorities when they've kicked health care providers out of their Medicaid programs for incompetence, fraud and other reasons,..."

"...61 percent of the 4,319 sanctions imposed by state Medicaid agencies in 2004 and 2005 could not be found in the federal database."


"...two states that suspended the largest number of providers, New York and Florida, had the lowest matching rates,21 percent and 9 percent respectively."



WASHINGTON — In violation of federal law, states routinely fail to notify federal authorities when they've kicked health care providers out of their Medicaid programs for incompetence, fraud and other reasons, government investigators have found.

The lack of notice makes it easier for barred providers to set up shop in other states and to continue getting payments from federal health programs.

The inspector general for the Health and Human Services Department maintains the list of health care providers prohibited from getting any federal health reimbursements. Last year, the IG's office added 3,308 people and organizations to that database, but probably could have added many more, according to a survey that investigators conducted recently.

Investigators surveyed the states to find out how often their Medicaid programs sanction a provider in a way that would in the vast majority of cases merit a spot in the IG's exclusion database. An astounding 61 percent of the 4,319 sanctions imposed by state Medicaid agencies in 2004 and 2005 could not be found in the federal database.
States with high match rates tended to be states that took action against more than 100 health care providers, though that wasn't always the case. Alabama, Louisiana and Texas had the highest match rates. More than 80 percent of the providers suspended from their state Medicaid programs could be found on the national list.
However, the two states that suspended the largest number of providers, New York and Florida, had the lowest matching rates, 21 percent and 9 percent respectively.

About a dozen states submitted incomplete data or reported not taking any action against health care providers in 2004 and 2005. Among them were California and Michigan, two states with large Medicaid populations.

Jeff Nelligan, a spokesman for the Centers for Medicare and Medicaid Services, said the agency agrees there's room to increase the number of referrals from the states. It will "strive to reduce the barriers that may currently exist," he added.

In all, 47 states responded to the survey. State officials frequently said they were unclear about what kind of information was supposed to be forwarded to the HHS inspector general.

"It would be handy to have a little cheat sheet that clearly stated refer these cases with this info," an unidentified state official wrote.

Another state official wrote that until they had responded to the inspector general's survey, "no coordinated effort existed ... to make referrals."

Reasons for exclusion from federal health programs include convictions for fraud and patient abuse, licensing board sanctions and default on federal health education loans. Under law, no federal payment can be made for anything that an excluded person furnishes, orders or prescribes.

http://www.huffingtonpost.com/huff-wires/20080812/health-fraud/

Sentenced to More Than 12 Years in Prison for conspiring to defraud Medicare, taking kickbacks and other related charges

Florida Pharmacy and Medicare Equipment Company Owner Sentenced to More Than 12 Years in Prison for Medicare Fraud (07-773)

WASHINGTON – The owner and operator of a Florida pharmacy and Durable Medicare Equipment (DME) company has been sentenced to 151 months in prison for Medicare fraud, (Read more)
FOR IMMEDIATE RELEASE
FRIDAY, SEPTEMBER 28, 2007
WWW.USDOJ.GOVCRM
(202) 514-2007
TDD (202) 514-1888

Florida Pharmacy and Medicare Equipment Company Owner Sentenced
to More Than 12 Years in Prison for Medicare Fraud
Medicare Fraud Strike Force Has Charged 120 Defendants With Medicare Fraud Since March
WASHINGTON – The owner and operator of a Florida pharmacy and Durable Medicare Equipment (DME) company has been sentenced to 151 months in prison for Medicare fraud, Assistant Attorney General Alice S. Fisher of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida announced today.

Nelson Valdes was sentenced yesterday by U.S. District Judge Cecilia M. Altonaga in Miami. Judge Altonaga also ordered Valdes to pay almost $3.5 million in restitution for the money he received in false claims. A federal jury in Miami convicted Valdes of conspiring to defraud Medicare, taking kickbacks and other related charges, after a five-day trial in July 2007. The guilty verdict represented the third time Valdes had been convicted of Medicare fraud.

Valdes owned Florida Pharmacy and Discount and F & M Medical Rentals Inc. from March of 2000 to July 2007. In September of 2001, Valdes conspired with the owners of Med-Pro Billing and Unimed Pharmacy to refer paid patients in exchange for half of what Medicare paid for “compounded” aerosols. Compounding refers to the process of a pharmacist making medication as opposed to a pharmaceutical manufacturer.

After Unimed Pharmacy was shut down in 2003 by the FBI, Valdes obtained a pharmacy license through the assistance of Benjamin Metsch, an attorney convicted of Medicare fraud in 2006, and continued to compound medication for his paid patients. From 2001 to 2003, Unimed collected $7 million for aerosols, and from 2000 to 2007, Valdes' pharmacy and DME company collected in excess of $3 million for aerosols and equipment.

The compounding aerosol scheme was one of the most common health care frauds in south Florida. In 2006, the Medicare program paid for over $155 million worth of aerosol medications in Miami-Dade County, making it the single most common item billed to Medicare Part B. From 2005 to 2006, claims for these aerosol medications increased over 100 percent. In addition, according to Medicare data, Miami-Dade County alone accounted for more paid DME claims than every state in the country except California, Texas, New York, Michigan and Ohio.

The case was prosecuted by Deputy Chief Kirk Ogrosky and Trial Attorney John S. Darden from the Fraud Section of the Criminal Division, with the investigative assistance of the U.S. Department of Health and Human Services, Office of the Inspector General, the FBI, and the Medicaid Fraud Control Unit of the Florida Attorney General’s Office.

Since beginning operations in March of 2007, the strike force teams have indicted approximately 80 cases and 120 defendants in Miami-Dade County alone. The strike force teams are led by a federal prosecutor supervised by both the Criminal Division’s Fraud Section in Washington and the U.S. Attorney’s Office of the Southern District of Florida.

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07-773