Washington Post Examines Medicare’s ‘Growing Fraud Problem’

The Washington Post on Friday examined Medicare's "growing fraud problem and the need to devote more resources to theft prevention." According to the Post, law enforcement officials estimate that health care fraud costs taxpayers more than $60 billion annually. HHS Inspector General Daniel Levinson has said repeatedly that Medicare is "highly vulnerable" to fraud. Fraud "hot spots" include South Florida -- "where schemes center on expensive, infusion-based HIV medications and on equipment such as wheelchairs, walkers, canes and hospital beds" -- as well as Houston and Los Angeles, the Post reports.

The Post profiles the case of Rita Campos Ramirez, owner of Miami-based R and I Medical Billing, who "orchestrated what prosecutors call the largest health care fraud by one person." Between 2002 and 2006, Campos Ramirez electronically billed Medicare for more than 140,000 unnecessary claims and medical services by offering kickbacks to "sham" medical clinics and physicians who falsely claimed to have received the services and equipment, the Post reports. The scheme resulted in more than $100 million in fraudulent Medicare payments, of which Campos Ramirez personally received $5 million.

"Health care experts say the simplicity of Campos Ramirez's scheme underscores the scope" of the problem, according to the Post. One "critical aspect of the problem is that Medicare ... automatically pays the vast majority of the bills it receives from companies that possess federally issued supplier numbers," the Post reports. Scholars say that Medicare's current computer and audit systems generally focus on overbilling or unorthodox medical treatments, rather than fraud.

CMS officials are working to improve fraud efforts "by working closely with investigators, removing the requisite billing numbers of nearly 900 companies and imposing new standards in high-fraud areas that would prevent people convicted of felonies from ever receiving a Medicare number," according to the Post. Kimberly Brandt, director of program integrity at CMS, said, "There's always more fraud than we have resources to combat," adding, "We have done a much better job of realigning our resources to attack this problem" (Johnson, Washington Post, 6/13).