On Jan. 13, Renier Vicente Rodriguez Fleitas was sentenced to three years in federal prison for conspiring to bilk Medicare through his Hialeah pharmacy. In his plea deal, Rodriguez admitted that he billed about $1.8 million in false claims under Medicare Part D. He was ordered to repay $135,930, what he received in reimbursements, to Medicare.
This most recent Medicare-fraud case was chump change by Miami standards. We are the nation's Medicare-fraud capital, after all, where millions of federal-healthcare dollars have been stolen in some spectacularly brazen cases.
Still, Rodriguez's repayment will be counted as stolen Medicare funds recovered this year by the federal government, which in 2010 retrieved $4 billion in fraud judgments. That's a record high -- up by 50 percent from 2009. Good news, right?
More like a drop in the bucket. Authorities estimate that Medicare fraud bilks the U.S. government as much as $60 billion to $90 billion a year. Of that, Miami accounts for about $3 billion. Medicare scams have become so lucrative, the FBI says, that the mob is getting in on them.
Much of the fraud stems from inadequate screening of providers and an antiquated system that pays up front, then must backtrack to weed out fraudulent claims through what authorities call the ``pay and chase'' process. By the time the fed's creaky system catches up with suspicious billing patterns, many crooks have already opened new accounts. Or they take their illicitly gotten millions and leave the country.
The U.S. Health and Human Services Department and the Justice Department have deployed task forces to Miami and other trouble spots to root out fraud. This is paying off. Arrests are up, and recovery of wrongful payments has increased.
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