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Hotline being used to combat medicare fraud

Posted on April 19, 2010 12:00 AM EST

Another tool implemented by federal authorities to uncover and prosecute healthcare fraud scams now includes a hot line. The Florida consumer hot line accepts calls from Medicare beneficiaries whose accounts have been billed for medical treatments or medical supplies that were never provided or received. About 80 irate senior citizens contacted the hot line after they received bills indicating that a Miami clinic had submitted bills on their behalf. All of the calls occurred in May 2009, which led to an indictment by September 2009. Federal authorities arrested Filibereto Ramos for Medicare fraud after his company fraudulently billed the federal healthcare program approximately $3.1 million. Ramos received approximately $1.9 million for treatment never provided to patients.

Last month, Ramos entered a guilty plea in federal court and was sentenced to three years in prison. Present with Ramos at his sentencing hearing was his Miami criminal defense lawyer. Despite the number of Medicare fraud prosecutions over the past couple of years, this case is notable because it is the first major prosecution in South Florida that stemmed from complaints or tips received from by the hot line. It is also the first time a clinic owner and operator was prosecuted as a result of the information received by the hot line. The hot line is operated by Safeguard Services and has dozens of people accepting calls in Miramar, Florida. The call center is open 24 hours a day, 7 days a week in an effort to obtain information about clinics fraudulently billing for healthcare services.

The hotline was created in 2008 and was largely ineffective due to under staffing. Many complaints regarding fraud went unanswered and phone calls were unlikely to be returned. At the cost of millions of dollars, the hotline expanded the operation to include 15 telephone operators and 15 investigators. The operators at the hot line speak both English and Spanish. They are responsible for taking down the beneficiary's information and billing history. Once the information has been collected, the information is passed on to the investigative team for follow-up. The majority of the phone calls are regarding billing mistakes while about 15% are related to un-provided services. If the information is considered related to fraud, it is sent to the investigative team that is headed up by a retired FBI agent.

Another example of the Safeguard System led to the closure of another Miami-Dade County clinic. Several tips were provided regarding a medical supply company in Little Havana. While the owners of the company were able to bill for $2 million and received $500,000 for goods never provided, their access to billing was immediately shut down. Once investigators located the business, the owners had already abandoned the business. While the culprits got away, they were unable to continue their operation. The Safeguard System is another example of the measures being taken to shut down the Medicare fraud problem. Clinic owners and medical supply businesses should be aware that investigative measures will only become more sophisticated as more funding and manpower is thrown at the problem.

Medicare's Fraud Hot Line Begins to Root out Billing Scams, The Miami Herald.com, April 17, 2010.
Categories: Fraud