Scarlet Duarte and Rechart Garcia face prison terms of five to 20 years for submitting almost $52 million in false claims for HIV infusion treatments that -- even if they had been used on AIDS patients -- are medically questionable at best.
The convictions last week of the clinic operators on various charges of conspiracy, health are fraud and money laundering involving six clinics in Miami-Dade and Collier counties illustrate the problems with the current system, which still lacks sufficient front-end mechanisms to prevent and detect fraud.
That's at the heart of the Obama administration's health care reform. Unless the system can catch abuses with the first medical bill sent to Medicare, which covers seniors, or Medicaid for the poor, there will be no cost savings to expand insurance to millions who now don't have coverage. And unless penalties for fraudsters who steal millions of dollars are toughened so that the prison sentence is more than a legal slap, they'll keep scamming.
In this case, Medicare paid the clinics more than $21 million, and the operators paid kickbacks to Medicare patients who were in on the scam. Then the taxpayers' money was laundered through shell companies, according to prosecutors.
Why wasn't this scam caught with the first bill of a therapy that medical experts most everywhere else find is no longer medically necessary?
Federal prosecutors in Miami have been tracking scammers aggressively since 2005, charging more than 900 Medicare offenders involving more than $2 billion in false claims. Nationwide, taxpayers are hit with $60 billion in healthcare scams each year, and South Florida is at the center of the abuse.
To read the complete editorial, visit The Miami Herald.
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