Is this a great country or what? Newly arrived immigrant gangsters from Armenia have helped themselves to the largess of Medicare to the tune of $35 million dollars and more by creating a loose network of false health clinics, staffed by real physicians and patients whose identities had been stolen. The gang operated 118 of the non-clinics in 25 states. In matching the stolen identities of physicians with the stolen identities of patients the thieves were able to bilk the federal government of millions by submitting false claims that were paid without pre-verification, which is the way Medicare works.
Most of the billings seemed authentic on the surface but there were certain outliers where forensic pathologists were billing for heart tests ( Arguably one should make sure the patient’s heart is not beating before starting the autopsy) and a pregnant woman obtaining an ultrasound from ENT physician. The criminal enterprise apparently laundered the money using check cashing facilities and gambling casinos in Los Vegas.
Much of the money ended up being siphoned to Armenia. The arrests of 42 conspirators were described today in the New York Times Article “Real Patients, Real Doctors, Fake Everything Else,” reported by Michael Wilson and William K. Rashbaum.
This is one of the many hazards associated with fee for service medicine which relies on the trust and honesty of doctors to make the system work. If a gangster can’t find a corrupt physician and a corrupt patient to assist in ripping of the government, why modern technology still permits identity thieves to cash in on a vulnerable process by creating a false universe of services among real people. This should change as HHS begins implementing accountable care organizations, but there will always be someone with the capability and desire to game the system.
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