AARP Bulletin - November 2010

Your Health ;
; Can it stop the crooks?

Federal agents rose before dawn on a muggy morning last summer, donning bulletproof vests as theyprepared to sur-
prise and arrest an established Miami physician.
Armed with guns and heavy flashlights, they
scaled a high stucco wall to enter the grounds
of his sprawling two-story home, fanned out
around the pool and house and waited; then
several agents pounded on the door, shouting,
“This is the FBI!”
The 56-year old doctor, Jorge
J. Dieppa, was wanted on
charges of taking bribes to
provide hundreds of patient
referrals to home health care
agencies that then submit-
ted about $19 million
in phony claims to
Medicare. The
program paid al-
most $12 million
to his alleged
ring of scam-
mers: six nurses, two
patient recruiters and a
Medicare beneficiary who received kickbacks.
Nothing out of the ordinary for Miami, the na-
tion’s capital of Medicare fraud, where medical
equipment, physical therapy and other scams
overseen by doctors, nurses and health company
CEOs have been rampant for the past decade.
But outside Miami, dozens of other people also
were charged with Medicare crimes that same
summer day—in Brooklyn, N. Y.; Baton Rouge,
La.; Detroit; and Houston—all part of the larg-
est health care fraud takedown in the nation’s
history. More than 350 law enforcement o;cers
arrested 94 suspects accused of trying to bilk
Medicare of $251 million by billing the program
for medical services and equipment that were
either unnecessary or never provided.
News cameras
caught the sus-
pects as officials
marched them off
to jail. Some hung
their heads or tried
to cover their faces
with jackets. One
woman spit defi-
antly at the cam-
era. Among other
crimes, they were
accused of charg-
ing Medicare for
physical and oc-
cupational therapy never performed and HIV
infusions—a treatment outdated for the last
decade—that patients never received. Court
documents revealed 3,700 claims for one wom-
an during a six-year period.
For the Obama administration, the sweeping
THE FRAUD
Medicare paid
almost $12 million
to Dieppa’s alleged
ring, accused of
working with health
care agencies that
submitted $19 million
in phony claims.
Total: Medicare
fraud costs $60
billion a year.

arrests were a “shock and awe” show of force
designed to send a message that it means busi-
ness about Medicare fraud. The day of the ar-
rests, the administration held its first health-
care fraud prevention summit in Miami, where
U.S. Attorney General Eric Holder declared the
government’s goal is to “hammer people” who
steal from the $500 billion program for older
and disabled Americans. But that’s a tough job.
Medicare is now a magnet, not only for unscru-
pulous health care workers, but also for violent
felons and mobsters, who consider cheating
the system safer, easier and more lucrative than
drug dealing.
And the estimated cost of their fraud each
year? $60 billion.
The Justice Department, which launched the
first Medicare fraud strike force with the U.S.
Attorney’s O;ce in Miami in March 2007, has
expanded that law enforcement program to
six other cities: Los Angeles, Houston, Detroit,
Brooklyn, Baton Rouge and Tampa, Fla. The
results so far include indictments of more than
800 defendants who submitted nearly $2 billion
in allegedly bogus bills to Medicare.
The ultimate plan is to establish 20 strike forc-
es—made up of hundreds of FBI agents and agents
from the U.S. Department of Health and Human
Services—that will be deployed around the coun-
try. “Our intention is to find people and put them
in jail,” Holder said flatly. After years of infect-