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Lawmakers Launch Bipartisan Effort Against Medicare Fraud
By Brian Bandell, The South Florida Business Journal
April 13, 2010
Congressman Ron Klein, D-Boca Raton, and Congresswoman Ileana
Ros-Lehtinen, R-Miami, introduced the Medicare Fraud Enforcement and Prevention Act on Tuesday.
Two South Florida lawmakers on opposite sides of the political fence have introduced a bill designed to fight the $1 billion Medicare fraud problem.
In one of the first bipartisan efforts since the divisive passage of federal health care reform, Congressman Ron Klein, D-Boca Raton, and Congresswoman Ileana Ros-Lehtinen, R-Miami, introduced the Medicare Fraud Enforcement and Prevention Act on Tuesday to a packed crowd at a Little Havana senior community center.
The bill would double the penalties for Medicare fraud, give law enforcement new tools to detect and prosecute fraud and step up screening of those who want to set up health care companies and bill the Medicare program.
Klein, who authored the bill, plans to introduce it in Congress by Wednesday. Ros-Lehtinen is one of 10 co-sponsors.
“We’re working together on this bipartisan measure to help legitimate clinics and doctors so we can stop illegitimate providers who bilk the system, so people like you can’t get the care that you need,” Ros-Lehtinen told the group of mostly Hispanic senior citizens. “We are going to put the rip-off artists in jail.”
Medicare fraud costs taxpayers $60 billion a year, and 20 percent of it originates in South Florida, according to Klein and Ros-Lehtinen. Authorities found $952 million in false Medicare claims in 2009, up from $703 million in 2008.
There has been an increase in fraud, despite the efforts of a federal health care fraud task force, which has prosecuted more than 800 people and identified more than $2.5 billion in fraudulent claims since it started in 2006.
Addressing the seniors, Ros-Lehtinen showed a recent article on the guilty plea of Miami resident Ihosvany Marquez, who orchestrated at least $61 million in false Medicare claims, costing the government $23.9 million.
The audience gasped as she told them about his fleet of luxury cars purchased with funds that were supposed to go toward their health care.
“This stops now,” Ros-Lehtinen said.
Klein said he used recommendations from law enforcement, prosecutors and Medicare officials to craft the legislation.
The bill would double the penalties for making false statements regarding federal health care services and violating the anti-kickback statues – bribing patients to accept phony services – to 10 years in prison and fines starting at $50,000 from five years in prison and fines starting at $25,000.
They noted that those sentenced for health care fraud usually get far less time in prison than criminals get for auto theft or robbery. However, Medicare fraud can prove to be more profitable for perpetrators.
The bill would also make it illegal to distribute Medicare or Medicaid beneficiary identification or billing privileges. That could draw a sentence of up to three years in prison, plus a fine equal to the amount stolen from the government.
“One of the main ways they ripped off the system was by stealing members’ numbers, selling them and billing on them,” Klein said.
The bill also calls for jail time for middlemen who sell the patient numbers, even if they aren’t directly involved in the fraudulent billing.
At a panel discussion in March, prosecutors on the Medicare fraud task force said they usually didn’t get access to suspicious Medicare billings until the money was already paid.
Klein said the bill’s goal is to prevent criminals from getting their first check.
On the front end, the bill would increase the number and scope of background checks and site visits for those who apply for Medicare billing numbers. While a review wouldn’t occur for every applicant, there would be indicators that set off red flags and require more applications to be reviewed to ensure that the people involved don’t have a troubled history, Klein said.
“The emphasis of the bill is stopping people from getting a provider number in the first place,” he said.
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