White collar crime may be a male-dominated area, but women are well capable of achieving the same notoriety. The home health care aid industry is dominated by women and much less visible than the HMOs and hospitals. With the limited investigative and enforcement resources available to the Federal government, Medicare fraud is a growing problem.
Medicare Fraud
Medicare fraud happens when a person submits false claims to a health care program run by the government. Recent government statistics suggest that about $50 billion per year are suspicious and can trigger Medicare fraud investigations.
Home health care
A mother and daughter, Mildrey Gonzalez and Milka Alfaro, were recently convicted of Medicare fraud in a scheme involving home health care agencies. They were sentenced to 10 years in prison. The two Florida residents were flying to Miami from the Dominican Republic when customs agents inquired as to how much currency the two were carrying, a common question. Cash up to $10,000 can be legally carried on one’s person, but they were found to be transporting two and a half million dollars in cash packed between baby diapers and baby wipes.
The cash became evidence in a Medicare fraud case which was part of scams that bilk the taxpayer out of some $100 billion a year. Miami is just one of a dozen cities known to have a high incidence of billing fraud. The recent case of several assisted living residents dying from the heat in the wake of hurricane Irma shows just how unchecked these facilities can be.
Ownership and performance records of these facilities can be hard to investigate. Civil Investigative Demand (CID), a tool used by government investigators to gather information and evidence, is labor-intensive and tedious.In the case of Gonzalez and Alfaro, they secretly owned seven home healthcare agencies and Medicare fraud brought them $20 million over a six-year period. They paid recruiters bonuses to find them clients – even clients who did not qualify for their services. They also paid out kickbacks to medical professionals to write prescriptions for services and referrals to the agencies they owned.
Women posing as owners
While hiding their own identities as owners, Gonzalez and Alfaro hired other people to pose as owners in order to hide their operation from the Feds. They went so far as to coerce witnesses into lying about what they owned. Bringing a couple million dollars in cash back into the US was a little odd, but illustrates the amount of money necessary to pay for shady services in this business.
Health Care Fraud is a Priority Issue
US Attorney General Jeff Session has made investigating health care fraud a priority since he took the position in the Trump administration. Total health care spending in the US was $3.2 trillion in 2015, amounting to 18 percent of the entire US GDP (gross domestic product). The Department of Justice has 56 prosecutors that focus entirely on healthcare. Since 2007, they have charged 3,200 people with fraud of over $11 billion.
Huge, but just a drop in the bucket.