Miami: Medicare fraud's national capital

MIAMI — Whenever Alexander McCray lights up his crack pipe, U.S. taxpayers help pay for his habit.

McCray has defrauded Medicare by selling his government-issued health card number to private clinics in exchange for kickbacks of $150 to $300 a visit — as often as three times a day, three times a week over seven years, according to federal records and his own admission.

The 40-year-old, unemployed Opa-locka man has signed off on phony infusion treatments for his HIV illness — therapy that is medically obsolete — and he has received thousands of dollars from Medicare-licensed clinics all over South Florida.

Dozens of clinic operators have in turn filed more than $1.1- million in false claims for fabricated HIV infusion treatments billed in his name, according to Medicare records reviewed by the Miami Herald. Ninety doctors, including one indicted in May, appeared on the phony prescriptions written on behalf of McCray.

McCray, a "professional patient" with a 15-year criminal history of drug possession, is among thousands of con artists who have made South Florida the nation's capital of Medicare fraud. A six-month Herald investigation has found that the corruption has spun out of control during the past decade with little effort by Medicare regulators to stop it. Federal lawmakers estimate Medicare fraud costs taxpayers nationwide at least $60-billion a year.

Private health care companies, credit card companies and other industries have implemented new technology to fight fraud aggressively, but Medicare has failed to adopt even the most basic changes that the Health and Human Services Department's inspector general has warned are needed to combat the crisis.

Consider this statistic: In 2005, South Florida clinics — mostly concentrated in Miami-Dade — submitted $2.2-billion in HIV drug infusion bills to Medicare, according to the inspector general. That was 22 times the total HIV infusion claims submitted to Medicare by clinics in the rest of the country combined.

In addition, false claims for medical supplies such as motorized wheelchairs, glucose monitors and oxygen equipment run into the hundreds of millions of dollars annually in South Florida.

These two areas of health care corruption, which have become targets of heightened federal prosecutions, account for at least $2.5-billion in Medicare fraud annually in South Florida, according to authorities.

"I knew Miami was bad, but I was shocked when I got here," said Timothy Delaney, assistant special agent in charge of the FBI's office in Miami and the head of the bureau's national health care fraud program from 2000 to 2004. "There is fraud here like nowhere else in the country."

South Florida's U.S. attorney, R. Alexander Acosta, placed much of the blame on Medicare and its system of screening bills, saying its poor oversight forces authorities to chase criminals long after they have absconded with taxpayer dollars. Little of the money is recovered.

A Herald review of FBI, U.S. attorney and federal court records found that at least 56 of the roughly 700 Medicare fraud defendants are fugitives — with at least 18 suspected of having fled to Cuba during the past five years.

Cuban immigrants make up the vast majority of defendants prosecuted on charges of submitting billions of dollars in false Medicare claims since 2004, records show.

Among them: the Benitez brothers, charged with defrauding Medicare by billing $110-million in false claims for HIV drug infusion treatments at their dozen clinics in Miami-Dade County. Medicare paid their companies about $84-million between 2001 and 2004, according to federal prosecutors.

After being indicted on federal fraud charges in Miami in late May, Carlos, Jose and Luis Benitez fled to Cuba.

The temptation of health care fraud is great because almost anyone can become a Medicare operator — even a drug dealer.

Angel Castillo Jr., a high school dropout with a federal drug-trafficking conviction, pleaded guilty in December to running eight medical equipment companies under others' names and submitting more than $48-million in false claims to Medicare.

He said he pulled it off by buying lists of Medicare patients and using physicians' identification numbers on the Internet for prescriptions.

While his bogus businesses raked in about $8-million in 2005-06, he personally pocketed more than $2-million.

Miami: Medicare fraud's national capital 08/16/08 [Last modified: Sunday, August 17, 2008 8:35pm]

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