The FBI has carried out the largest operation in history in the fight against health insurance fraud.
It is mainly about the federal health insurance Medicare, introduced in 1965 and covering the disabled and all Americans over 65 years old.
Prosecutors say that in total, the fraudsters defrauded the Medicare program of about a quarter of a billion dollars by billing it fake bills for unnecessary or nonexistent medical procedures and equipment, such as wheelchairs.
Criminal cases have been filed against 94 people in five states across the country.
Last Friday, swat teams totaling more than 350 law enforcement officers arrested 36 of them in Boston, Detroit, Baton Rouge, Louisiana, New York and Miami.
The arrests continue through the weekend.
Scammers in Miami
The defendants include doctors, nurses, clinic owners and individuals who found them fake patients – accomplices who, for money, allowed the scammers to use their names and Medicare enrollment numbers.
The scammers billed the program for procedures the people supposedly underwent at their clinics, or for crutches, braces or wheelchairs they supposedly received on doctor’s orders.
The scams charged in the case follow a long-established pattern and are so widespread that authorities estimate Medicare loses between $60 billion and $90 billion a year on them.
The scammers are operating in every U.S. state, but are particularly active in Florida. “The scope of fraud in this area of the country is truly staggering,” writes the Miami Tribune.
Florida’s chief federal prosecutor Wilfredo Ferrer said at a press conference on the arrest of the fraudsters that he was embarrassed for his state, which enjoys “a dubious reputation as the epicenter of medical scams.”
The following fact is pointed out in this regard. Last year, Florida’s mental health facilities submitted $421 million in bills to the Medicare program.
That’s about four times as much as Texas and 635 times as much as Michigan. Federal authorities find this highly suspicious.
There are now 24 people in and around Miami facing trial, accused of submitting $103 million worth of phony accounts to the program.
Children of different nations
Children of different nations have been accused of scams. For example, the list of those arrested in Detroit includes Richard Shannon, Chiradeep Gupta, Vishnu Pradeep Medu, Hasan Akhtar and Curtis Mallory.
In Brooklyn, six patients who sold their services to multiple clinics at once have been brought to trial.
Among them is Valentina Mushynska, an 82-year-old Ukrainian woman on whose behalf at least 3,744 bills were submitted for payment over the past six years.
After a brief court procedure, Mushinskaya was released on $30,000 bail and told not to show her face again at the local Solstice Wellness Center clinic, which is accused of defrauding Medicare of nearly $3 million.
The DOJ has filed a case against Ilya Gershkovich and Pelagea Kotelskaya, who allegedly found “professional patients” for this clinic who were willing to participate in the scam.
Between January 2004 and February 2010, an average of 2,200 invoices were submitted for payment in the name of each of these patients.
But Mushinskaya was the all-time record holder among them.
Prosecutors call Mushinskaya a “serial user” of the Medicare program, with $141161 in bills paid on her behalf.
Mushinskaya’s nephew, Vladimir Olshansky, told reporters that she has diabetes and “has no idea what’s going on.”
Igor Loshakov, an orthopedic doctor, is accused of participating in a scam in which bills for mythical medical procedures were submitted to authorities. Authorities say the scheme cost them $730,000.
Kickback Room
The case of doctors Gustav Drivas and Jonathan Wahl from the well-known Brooklyn clinic Bay Medical and their alleged accomplices Sergei and Irina Shelikhov, Leonid Zheleznyakov, Elena Girenko, Katerina Kostyuchenko and Veronica Chernichenko has attracted special media attention.
They allegedly submitted for payment fake invoices worth 72 million dollars.
Authorities installed microphones and video cameras in the room of the clinic where the “professional patients” were paid for the right to use their names and Medicare numbers.
From April through June 2010, the equipment captured about a thousand episodes of kickback payments to these people, who received a total of $500,000 during that period.
“Kickback room” was decorated with old Soviet posters with slogans like ‘Don’t talk!’. As Brooklyn federal prosecutor Loretta Lynch gleefully noted at a press conference, the walls of this room, however, had ears.
Finally, in Brooklyn, Oleg Kam and Oleg Hason, president and vice president of Best Equipment Medical Supplies, were brought to trial for allegedly siphoning off $790,000 from Medicare by submitting phony bills for mythical orthopedic equipment.
Medical fraud, to which the local mafia did not fail to get involved, has taken on such a scale in the U.S. that in March 2007 the authorities created special groups to combat such scams.
Since then, a total of 810 individuals and organizations have been brought to trial for defrauding the public health insurance system of almost $2 billion.
Source: https://www.bbc.com/russian/international/2010/07/100717_medicare_fraud