Health care fraud: Not a faceless crime any longer

WASHINGTON (AP) - Health care fraud once was a faceless crime. Now it has a mug shot, even a smile.

Medicare and Medicaid scams cost taxpayers more than $60 billion a year, but bank holdups are more likely to get greater attention.

The government wants the public's help in trying to catch more than 170 fugitives wanted for fraud, so it's developed a new health care most-wanted list, with its own website - http://www.oig.hhs.gov . Most are dour; some sport smiles.

One name on the list is Leonard Nwafor, convicted in Los Angeles of billing Medicare more than $1 million for motorized wheelchairs that people didn't need. One person who got a wheelchair was a blind man who later testified he couldn't see to operate it.

Facing time in federal prison, Nwafor disappeared before his sentencing.

"We're looking for new ways to press the issue of catching fugitives," said Gerald Roy, deputy inspector general for investigations at the Health and Human Services Department. "If someone walks into a bank and steals $3,000 or $4,000, it would be all over the newspaper. These people manage to do it from a less high profile position, but they still have a tremendous impact."

Even though motorized wheelchairs can cost up to $7,000 apiece, Nwafor's scam was on the low end when compared with others who made the most-wanted list.

Sisters Clara and Caridad Guilarte allegedly submitted $9 million to Medicare in false and fraudulent claims for pricey infusion drugs that were never provided to patients. They are accused of offering cash and other rewards for beneficiaries to visit their clinic in Dearborn, Mich., and sign forms that said they received services that they never got.

An alleged accomplice was arrested in the Dominican Republic recently, but the sisters remain at large.

Scammers "often utilize their ties to a particular community," said Roy. "They take advantage of ethnic communities based on language barriers or lack of knowledge about how the Medicare system works. These folks are exploiting low-income communities."

Fugitive Susan Bendigo is accused of billing California's Medicaid program for $17 million in nursing care, much of which was performed by staffers who weren't licensed. A registered nurse, Bendigo was the nursing director for a company that provided personnel for home health agencies. Allegedly, she was fully aware that she was required to send licensed nurses to care for patients.

Topping the list are Miami brothers Carlos, Luis and Jose Benitez. Owners of a string of medical clinics, they allegedly scammed Medicare out of $119 million by billing for costly HIV drugs that patients never received or did not need. Authorities say they bought hotels, helicopters and boats before fleeing to Cuba.

The FBI has the marquee most-wanted list, but the Environmental Protection Agency and other federal agencies also maintain their own.

Roy said he hopes this newest list will raise awareness about the importance of combatting health care fraud. Medicare and Medicaid, which provide care for about 100 million people in the U.S., are in serious financial trouble and can't afford to be hemorrhaging tens of billions a year because of fraud.

Most people go to elaborate lengths to avoid having their scams detected. But there often is a telltale sign.

To document his transactions, wheelchair purveyor Nwafor assembled elaborate paper files, complete with bogus prescriptions and photos of beneficiaries in their wheelchairs. But investigators had a hunch they were on to something when they discovered that most of his customers lived nearly 200 miles away from his Los Angeles-area store.

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Online:

http://www.oig.hhs.gov