Unfortunately, Medicare fraud is outrageously profitable and rather low risk.  Miami is the current Medicare fraud capital of the country.  Schemes that are launched there are perfected and then exported to other parts of the nation.  Situations could involve setting up health care clinics (many often just empty storefronts or post office boxes) and then charging Medicare millions of dollars for therapies that were never actually performed.  Criminals learn to submit their bills correctly for bogus claims, and they are compensated in full and in a timely manner by a computer, with no human interaction at all.

Individuals running these scams obtain Medicare numbers by stealing or buying them from doctors, clinics or patients.  In one documented circumstance, one Medicare number in the wrong hands triggered payment of more than $1 million for phantom care.

Estimates of losses due to national Medicare fraud range from $11 billion to $60 billion.  Arriving at an exact figure calculated by industry experts is difficult.

Medicare’s vulnerability to crooks is due somewhat to the fact that the enrollment program is based on an honor system that is evidently broken.  Medicare’s anti-fraud budget is obviously inadequate.  This year Congress is allocating an additional $200 million for that budget with another $300 million scheduled for 2010.  Hopefully, this money will help the agency upgrade its computer software to flag suspicious bills, to call for more investigations of dubious claims, and to make more random visits to providers.  The Obama administration feels that health care reform can be significantly financed with anticipated savings derived from cracking down on Medicare fraud.

Gerri Tyber, Operations Manager
Barton Home Care